Provider Demographics
NPI:1902029275
Name:KOSTERS, DIANE K (PHD)
Entity Type:Individual
Prefix:DR
First Name:DIANE
Middle Name:K
Last Name:KOSTERS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:445 LAKEWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94598-4838
Mailing Address - Country:US
Mailing Address - Phone:925-946-9660
Mailing Address - Fax:925-946-9660
Practice Address - Street 1:43 QUAIL CT STE 213
Practice Address - Street 2:
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94596-8702
Practice Address - Country:US
Practice Address - Phone:925-946-9660
Practice Address - Fax:925-946-9660
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY7055103G00000X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist