Healthcare Provider Details

I. General information

NPI: 1982633616
Provider Name (Legal Business Name): ELIZABETH KOSTREY, MD, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/03/2006
Last Update Date: 02/25/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2258 FOOTHILL BLVD SUITE300
LA CANADA CA
91011-1457
US

IV. Provider business mailing address

2258 FOOTHILL BLVD SUITE300
LA CANADA CA
91011-1457
US

V. Phone/Fax

Practice location:
  • Phone: 818-957-2248
  • Fax: 818-249-1425
Mailing address:
  • Phone: 818-957-2248
  • Fax: 818-249-1425

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License NumberA76521
License Number StateCA

VIII. Authorized Official

Name: DR. ELIZABETH KOSTREY
Title or Position: PRESIDENT
Credential: M.D.
Phone: 818-957-2248