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NPI Code Detail

MEDICARE: SOPHIA DE LEON

MEDICARE:   SOPHIA  DE LEON
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 TechnicianCA

General Provider Information

NPI Number : 1770414765
Entity Type Code : Individual
Provider Name (Legal Business Name) : SOPHIA DE LEON
Provider Business Mailing Address
First Line : 9376 MOONBEAM AVE UNIT 7
Second Line :
City : PANORAMA CITY
State : CA
Zip : 91402-1579
Country : US
Telephone Number : 747-253-2359
Fax Number :
Provider Business Practice Location Address
First Line : 15233 VENTURA BLVD STE 500
Second Line :
City : SHERMAN OAKS
State : CA
Zip : 91403-2231
Country : US
Telephone Number : 747-253-2359
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/27/2026
Last Update Date : 05/27/2026

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Directions to “ SOPHIA DE LEON ” Practice Location

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