Healthcare Provider Details

I. General information

NPI: 1316593916
Provider Name (Legal Business Name): JANICE MARIE ASTILLA AGNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2019
Last Update Date: 09/19/2026
Certification Date: 09/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1777 N BELLFLOWER BLVD STE 102
LONG BEACH CA
90815-4019
US

IV. Provider business mailing address

309 S LAXORE ST
ANAHEIM CA
92804-2056
US

V. Phone/Fax

Practice location:
  • Phone: 949-418-9482
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number95012205
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number95012205
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberNP95012205
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: