Provider Demographics
NPI:1700256328
Name:LOEGERING, LISA (MD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:
Last Name:LOEGERING
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:317 14TH ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:DEL MAR
Mailing Address - State:CA
Mailing Address - Zip Code:92014-2554
Mailing Address - Country:US
Mailing Address - Phone:858-222-0328
Mailing Address - Fax:858-275-6351
Practice Address - Street 1:317 14TH ST
Practice Address - Street 2:SUITE A
Practice Address - City:DEL MAR
Practice Address - State:CA
Practice Address - Zip Code:92014-2554
Practice Address - Country:US
Practice Address - Phone:858-222-0328
Practice Address - Fax:858-275-6351
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-25
Last Update Date:2017-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG506402080P0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0006XAllopathic & Osteopathic PhysiciansPediatricsDevelopmental - Behavioral Pediatrics