Provider Demographics
NPI:1548207152
Name:HUTHSTEINER, CONNY D (MD)
Entity Type:Individual
Prefix:
First Name:CONNY
Middle Name:D
Last Name:HUTHSTEINER
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 1:5805 WHITE OAK AVE UNIT 17225
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91416-5063
Mailing Address - Country:US
Mailing Address - Phone:818-578-5658
Mailing Address - Fax:818-578-5658
Practice Address - Street 1:4537 GABLE DR
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91316-4355
Practice Address - Country:US
Practice Address - Phone:818-578-5658
Practice Address - Fax:818-578-5658
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-01
Last Update Date:2012-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA815362084P0800X
CAC531582084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry