Provider Demographics
NPI:1992693857
Name:MONTIEL, SOFIA BELEN
Entity type:Individual
Prefix:
First Name:SOFIA
Middle Name:BELEN
Last Name:MONTIEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1407 S WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:COMPTON
Mailing Address - State:CA
Mailing Address - Zip Code:90221-5242
Mailing Address - Country:US
Mailing Address - Phone:323-975-1542
Mailing Address - Fax:
Practice Address - Street 1:879 W 190TH ST STE 1000
Practice Address - Street 2:
Practice Address - City:GARDENA
Practice Address - State:CA
Practice Address - Zip Code:90248-4255
Practice Address - Country:US
Practice Address - Phone:310-819-5423
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-27
Last Update Date:2025-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician