Provider Demographics
NPI:1558076737
Name:LOBERG, SOPHIE CHRISTINE (RD)
Entity Type:Individual
Prefix:
First Name:SOPHIE
Middle Name:CHRISTINE
Last Name:LOBERG
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3351 GRIM AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92104-4623
Mailing Address - Country:US
Mailing Address - Phone:320-292-4540
Mailing Address - Fax:
Practice Address - Street 1:3351 GRIM AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92104-4623
Practice Address - Country:US
Practice Address - Phone:320-292-4540
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-23
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4712133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered