Healthcare Provider Details

I. General information

NPI: 1609034578
Provider Name (Legal Business Name): LORRAINE M STANCO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2008
Last Update Date: 03/28/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7910 FROST ST STE 425
SAN DIEGO CA
92123-2795
US

IV. Provider business mailing address

7910 FROST ST STE 425
SAN DIEGO CA
92123-2795
US

V. Phone/Fax

Practice location:
  • Phone: 858-278-7400
  • Fax:
Mailing address:
  • Phone: 858-278-7400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberG63484
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License NumberG63484
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: