MEDICARE: SOPHIA ARIANA BOURRET

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1700729902
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SOPHIA ARIANA BOURRET

Provider Business Mailing Address
First Line	:	19032 DELIGHT ST
Second Line	:
City	:	CANYON COUNTRY
State	:	CA
Zip	:	91351-2803
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	22800 LYONS AVE
Second Line	:
City	:	NEWHALL
State	:	CA
Zip	:	91321-6800
Country	:	US
Telephone Number	:	805-936-0241
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/13/2026
Last Update Date	:	04/13/2026

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