Provider Demographics
NPI:1942236302
Name:LOSTRACCO, STEVE (CRNA)
Entity type:Individual
Prefix:
First Name:STEVE
Middle Name:
Last Name:LOSTRACCO
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 650802
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75265-0802
Mailing Address - Country:US
Mailing Address - Phone:972-715-5000
Mailing Address - Fax:
Practice Address - Street 1:146 E HOSPITAL DR
Practice Address - Street 2:SUITE 205
Practice Address - City:ANGLETON
Practice Address - State:TX
Practice Address - Zip Code:77515-4169
Practice Address - Country:US
Practice Address - Phone:979-848-3068
Practice Address - Fax:979-849-1423
Is Sole Proprietor?:No
Enumeration Date:2006-06-25
Last Update Date:2011-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX232302163WM0705X, 367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX130097204Medicaid
TX430044074OtherUNSPECIFIED RAILROAD MEDICARE
TX8672UAOtherBCBS
TX8672UAOtherBCBS
TX130097204Medicaid