Healthcare Provider Details

I. General information

NPI: 1962311621
Provider Name (Legal Business Name): ASTLA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/07/2026
Last Update Date: 09/07/2026
Certification Date: 09/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13015 PEMBERLEY PASSAGE AVE
BAKERSFIELD CA
93311-8734
US

IV. Provider business mailing address

13015 PEMBERLEY PASSAGE AVE
BAKERSFIELD CA
93311-8734
US

V. Phone/Fax

Practice location:
  • Phone: 415-770-2900
  • Fax:
Mailing address:
  • Phone: 415-770-2900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: MR. DARYL LAFOUNTAIN
Title or Position: EXECUTIVE DIRECTOR
Credential: MBA
Phone: 415-770-2900