Provider Demographics
NPI:1831603224
Name:WRENTMORE, SOFIA RAMIREZ SEPULVEDA (RD, MS)
Entity type:Individual
Prefix:MRS
First Name:SOFIA
Middle Name:RAMIREZ SEPULVEDA
Last Name:WRENTMORE
Suffix:
Gender:F
Credentials:RD, MS
Other - Prefix:
Other - First Name:SOFIA
Other - Middle Name:LORENA
Other - Last Name:RAMIREZ SEPULVEDA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10891 VIA LOMBARDIA APT 2505
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92129-1677
Mailing Address - Country:US
Mailing Address - Phone:805-729-0970
Mailing Address - Fax:
Practice Address - Street 1:10891 VIA LOMBARDIA APT 2505
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92129-1677
Practice Address - Country:US
Practice Address - Phone:805-729-0970
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-22
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA86092990133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty