Provider Demographics
NPI:1881607984
Name:LOSTETTER, ADRIENNE L (MD)
Entity type:Individual
Prefix:DR
First Name:ADRIENNE
Middle Name:L
Last Name:LOSTETTER
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 1:3860 CALLE FORTUNADA
Mailing Address - Street 2:STE 200
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-4802
Mailing Address - Country:US
Mailing Address - Phone:858-502-1135
Mailing Address - Fax:858-636-4319
Practice Address - Street 1:3030 CHILDREN'S WAY
Practice Address - Street 2:STE 112
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-4226
Practice Address - Country:US
Practice Address - Phone:325-677-2801
Practice Address - Fax:325-677-9110
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2015-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK2953208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8S7270OtherBCBS
TX134270OtherCHIP
TX8BQ021OtherBCBS
TX145585100OtherFIRSTCARE HMO
TX174705701Medicaid
TX134270OtherCHIP
TX145585100OtherFIRSTCARE HMO