Provider Demographics
NPI:1093761496
Name:LINSTONE, ELISSA M (MD)
Entity Type:Individual
Prefix:DR
First Name:ELISSA
Middle Name:M
Last Name:LINSTONE
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 1:4607 LAKEVIEW CANYON RD
Mailing Address - Street 2:597
Mailing Address - City:WESTLAKE VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91361-4028
Mailing Address - Country:US
Mailing Address - Phone:818-991-0595
Mailing Address - Fax:818-991-1507
Practice Address - Street 1:4607 LAKEVIEW CANYON RD
Practice Address - Street 2:597
Practice Address - City:WESTLAKE VLG
Practice Address - State:CA
Practice Address - Zip Code:91361-4028
Practice Address - Country:US
Practice Address - Phone:818-991-0595
Practice Address - Fax:818-991-1507
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2012-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC40477207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
A88179Medicare UPIN
WC40477BMedicare PIN