Provider Demographics
NPI:1295423127
Name:RENTERIA, SOPHIA MARIE (NURSE PRACTITIONER)
Entity type:Individual
Prefix:MRS
First Name:SOPHIA
Middle Name:MARIE
Last Name:RENTERIA
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4004 PEACHWOOD CT
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93309-6479
Mailing Address - Country:US
Mailing Address - Phone:661-336-8919
Mailing Address - Fax:
Practice Address - Street 1:2121 17TH ST STE A
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93301-3704
Practice Address - Country:US
Practice Address - Phone:661-323-3280
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-27
Last Update Date:2023-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95023926363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily