Healthcare Provider Details

I. General information

NPI: 1558809392
Provider Name (Legal Business Name): SONOYA MITCHELL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/01/2017
Last Update Date: 10/12/2023
Certification Date: 10/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10261 TRADEMARK ST STE C
RANCHO CUCAMONGA CA
91730-5805
US

IV. Provider business mailing address

11441 MAGNOLIA AVE APT 166
RIVERSIDE CA
92505-4897
US

V. Phone/Fax

Practice location:
  • Phone: 909-481-9333
  • Fax:
Mailing address:
  • Phone: 909-455-5840
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number12363621
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-15-06788
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: