Healthcare Provider Details

I. General information

NPI: 1770414765
Provider Name (Legal Business Name): SOPHIA DE LEON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2026
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15233 VENTURA BLVD STE 500
SHERMAN OAKS CA
91403-2231
US

IV. Provider business mailing address

9376 MOONBEAM AVE UNIT 7
PANORAMA CITY CA
91402-1579
US

V. Phone/Fax

Practice location:
  • Phone: 747-253-2359
  • Fax:
Mailing address:
  • Phone: 747-253-2359
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: