Sophie L. Prudencio, MA, BCBA

Primary specialty

Behavior AnalystTaxonomy code 103K00000X

License

1-13-13228 Issued in CA

Practice address

1411 W 190TH St Ste 110
Gardena, CA 90248-4370

Phone

(714) 834-1111

NPI assigned

Mar 5, 2013

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Arts

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1362441600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1687132800000",
    "number": "1942541693",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1411 W 190TH ST STE 110",
            "city": "GARDENA",
            "state": "CA",
            "postal_code": "902484370"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1411 W 190TH ST STE 110",
            "city": "GARDENA",
            "state": "CA",
            "postal_code": "902484370",
            "telephone_number": "714-834-1111"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "17609 Ventura Blvd Ste 215",
            "address_purpose": "LOCATION",
            "city": "Encino",
            "state": "CA",
            "postal_code": "913165126",
            "country_code": "US",
            "telephone_number": "818-501-8352",
            "fax_number": "818-501-8325",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PRUDENCIO",
        "first_name": "SOPHIE",
        "middle_name": "L.",
        "name_prefix": "Mrs.",
        "credential": "MA, BCBA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2013-03-05",
        "last_updated": "2023-06-19",
        "certification_date": "2023-06-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": "CA",
            "license": "1-13-13228",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Procare Medical Supply and Distribution Inc
• Lael Alexandria Proffit, NONE
• Project Snatched LLC
• Promed Medical Transportation Inc. Dba Promed Ambulance Service
• Providence Pharmaceuticals Inc
• Andrew Puente
• Andrea Pugh
• Imari Pugh
• Martha Puron, LMFT 152937
• Qismah, Inc

• Behavior Analyst in Gardena, CA
• Providers in Gardena, CA by specialty
• Behavior Analyst in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 19, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.