Provider Demographics
NPI:1407521347
Name:PUENTE, SOPHIE (MS, RDN, LD)
Entity Type:Individual
Prefix:
First Name:SOPHIE
Middle Name:
Last Name:PUENTE
Suffix:
Gender:F
Credentials:MS, RDN, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3880 CONNECTICUT ST APT A
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63116-4839
Mailing Address - Country:US
Mailing Address - Phone:507-581-6397
Mailing Address - Fax:
Practice Address - Street 1:230 S BEMISTON AVE STE 430
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63105-1907
Practice Address - Country:US
Practice Address - Phone:314-530-7400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-12
Last Update Date:2021-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2019046867133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered