=====================================================
General NPI Number Information
=====================================================
NPI Number | 1649081001
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SONIA RUTH PALOMINO AMFT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/15/2025
-----------------------------------------------------
Last Update Date | 01/15/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8142 SUNLAND BLVD
-----------------------------------------------------
City | SUN VALLEY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91352-3948
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-582-8832
-----------------------------------------------------
Fax | 818-582-8836
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 200 E ANGELENO AVE APT 325
-----------------------------------------------------
City | BURBANK
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91502-1360
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 626-633-2090
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number | 152500
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------