Provider Demographics
NPI:1851347769
Name:KOSTREY, ELIZABETH JANE (MD)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:JANE
Last Name:KOSTREY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MRS
Other - First Name:ELIZABETH
Other - Middle Name:JANE
Other - Last Name:HALL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2258 FOOTHILL BLVD
Mailing Address - Street 2:SUITE300
Mailing Address - City:LA CANADA
Mailing Address - State:CA
Mailing Address - Zip Code:91011-1457
Mailing Address - Country:US
Mailing Address - Phone:818-957-2248
Mailing Address - Fax:818-249-1425
Practice Address - Street 1:2258 FOOTHILL BLVD
Practice Address - Street 2:SUITE300
Practice Address - City:LA CANADA
Practice Address - State:CA
Practice Address - Zip Code:91011-1457
Practice Address - Country:US
Practice Address - Phone:818-957-2248
Practice Address - Fax:818-249-1425
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-25
Last Update Date:2011-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA765212084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry