Healthcare Provider Details

I. General information

NPI: 1760469662
Provider Name (Legal Business Name): KRISTAL T LOUIE M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/30/2005
Last Update Date: 03/26/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

950 28TH AVE WEST
VANCOUVER BC
V5Z4H4
CA

IV. Provider business mailing address

950 28TH AVE WEST
VANCOUVER BC
V5Z4H4
CA

V. Phone/Fax

Practice location:
  • Phone: 604-875-3015
  • Fax:
Mailing address:
  • Phone: 604-875-3015
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code170300000X
TaxonomyGenetic Counselor (M.S.)
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: