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General NPI Number Information
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NPI Number | 1508588039
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Entity Type | Individual
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Provider Name | KAYLEY ELIZABETH KRYSTKOWIAK MS, LCGC
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Gender | Female
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Dates
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Enumeration Date | 09/12/2022
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Last Update Date | 09/12/2022
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Provider Practice Location Address
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Address Line | 181 S BUENA VISTA ST STE 110
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City | BURBANK
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State | CA
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Zip | 91505-4504
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Country | US
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Telephone | 818-748-4748
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Fax | 818-748-4761
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Provider Business Mailing Address
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Address Line | 11972 BERRYBROOK CT
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City | MOORPARK
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State | CA
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Zip | 93021-3166
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Country | US
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Telephone | 805-279-3602
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 170300000X
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Taxonomy Name | Genetic Counselor (M.S.)
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License Number | GC001647
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License Number State | CA
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