Provider Demographics
NPI:1033254933
Name:LOUSTALET, CHERI MARIE (MS)
Entity Type:Individual
Prefix:
First Name:CHERI
Middle Name:MARIE
Last Name:LOUSTALET
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 HOLMAN RD
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94610-2542
Mailing Address - Country:US
Mailing Address - Phone:510-839-6070
Mailing Address - Fax:
Practice Address - Street 1:5300 MCCONNELL AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90066-7026
Practice Address - Country:US
Practice Address - Phone:800-426-6467
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA93093170300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS