Provider Demographics
NPI:1932318227
Name:SOSTOCK, LORI BETH (MD)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:BETH
Last Name:SOSTOCK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:820 DELNERO DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:SONORA
Mailing Address - State:CA
Mailing Address - Zip Code:95370-6208
Mailing Address - Country:US
Mailing Address - Phone:209-532-7246
Mailing Address - Fax:209-532-7722
Practice Address - Street 1:820 DELNERO DR
Practice Address - Street 2:SUITE B
Practice Address - City:SONORA
Practice Address - State:CA
Practice Address - Zip Code:95370-6208
Practice Address - Country:US
Practice Address - Phone:209-532-7246
Practice Address - Fax:209-532-7722
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2012-11-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA064650207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA05D2047923OtherCLIA WAIVER