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NPI Code Detail

MEDICARE: SOPHIA GONZALEZ

MEDICARE: SOPHIA GONZALEZ
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
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1881366284
Entity Type Code : Individual
Provider Name (Legal Business Name) : SOPHIA GONZALEZ
Provider Business Mailing Address
First Line : 119 W TORRANCE BLVD STE 100
Second Line :
City : REDONDO BEACH
State : CA
Zip : 90277-3600
Country : US
Telephone Number : 310-374-3300
Fax Number : 310-374-3307
Provider Business Practice Location Address
First Line : 5741 LAS VIRGENES RD STE A
Second Line :
City : CALABASAS
State : CA
Zip : 91302-1273
Country : US
Telephone Number : 818-712-8250
Fax Number : 818-712-8289
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/04/2021
Last Update Date : 12/11/2025

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Directions to “ SOPHIA GONZALEZ ” Practice Location

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