Provider Demographics
NPI:1619595238
Name:PABLEO, SOFIA COLEEN
Entity Type:Individual
Prefix:
First Name:SOFIA COLEEN
Middle Name:
Last Name:PABLEO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SOFIA
Other - Middle Name:
Other - Last Name:PABLEO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:11650 IBERIA PL STE 130
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92128-2431
Mailing Address - Country:US
Mailing Address - Phone:858-264-5858
Mailing Address - Fax:
Practice Address - Street 1:2820 CAMINO DEL RIO S STE 100
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-3822
Practice Address - Country:US
Practice Address - Phone:858-264-5858
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-09
Last Update Date:2023-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-23-65996103K00000X
106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician