Provider Demographics
NPI:1821007295
Name:KOSTALNICK, DANIEL JON (MD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:JON
Last Name:KOSTALNICK
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 849
Mailing Address - Street 2:
Mailing Address - City:LIVERMORE
Mailing Address - State:CA
Mailing Address - Zip Code:94551-0849
Mailing Address - Country:US
Mailing Address - Phone:925-784-4000
Mailing Address - Fax:925-426-0085
Practice Address - Street 1:2324 SANTA RITA RD
Practice Address - Street 2:SUITE 16
Practice Address - City:PLEASANTON
Practice Address - State:CA
Practice Address - Zip Code:94566-4152
Practice Address - Country:US
Practice Address - Phone:925-784-4000
Practice Address - Fax:925-426-0085
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2016-06-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA773862084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry