Healthcare Provider Details

I. General information

NPI: 1588540678
Provider Name (Legal Business Name): KAITLYN L. COSTAS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2025
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10323 SANTA MONICA BLVD STE 108A
LOS ANGELES CA
90025-5056
US

IV. Provider business mailing address

10323 SANTA MONICA BLVD STE 108A
LOS ANGELES CA
90025-5056
US

V. Phone/Fax

Practice location:
  • Phone: 310-340-0089
  • Fax:
Mailing address:
  • Phone: 310-340-0089
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95036353
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: