Healthcare Provider Details

I. General information

NPI: 1437098068
Provider Name (Legal Business Name): SOPHIE RENEE RATCLIFF RDN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2026
Last Update Date: 03/27/2026
Certification Date: 03/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1511 WAVERTREE LN
FULLERTON CA
92831-2218
US

IV. Provider business mailing address

1511 WAVERTREE LN
FULLERTON CA
92831-2218
US

V. Phone/Fax

Practice location:
  • Phone: 562-298-2446
  • Fax:
Mailing address:
  • Phone: 562-298-2446
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number86147862
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: