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General NPI Number Information
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NPI Number | 1669964805
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Entity Type | Individual
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Provider Name | KYRA MICHELLE FIRESTONE MS, LCGC
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Gender | Female
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Dates
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Enumeration Date | 06/04/2018
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Last Update Date | 01/05/2021
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Provider Practice Location Address
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Address Line | 9834 GENESEE AVE STE 128
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City | LA JOLLA
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State | CA
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Zip | 92037-1214
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Country | US
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Telephone | 858-824-5048
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Fax |
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Provider Business Mailing Address
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Address Line | 4011 LAMONT ST UNIT 3A
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City | SAN DIEGO
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State | CA
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Zip | 92109-6229
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Country | US
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Telephone | 310-961-6756
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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 | GC000992
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License Number State | CA
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