Provider Demographics
NPI:1508588039
Name:KRYSTKOWIAK, KAYLEY ELIZABETH (MS, LCGC)
Entity Type:Individual
Prefix:
First Name:KAYLEY
Middle Name:ELIZABETH
Last Name:KRYSTKOWIAK
Suffix:
Gender:F
Credentials:MS, LCGC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11972 BERRYBROOK CT
Mailing Address - Street 2:
Mailing Address - City:MOORPARK
Mailing Address - State:CA
Mailing Address - Zip Code:93021-3166
Mailing Address - Country:US
Mailing Address - Phone:805-279-3602
Mailing Address - Fax:
Practice Address - Street 1:181 S BUENA VISTA ST STE 110
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91505-4504
Practice Address - Country:US
Practice Address - Phone:818-748-4748
Practice Address - Fax:818-748-4761
Is Sole Proprietor?:No
Enumeration Date:2022-09-12
Last Update Date:2022-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAGC001647170300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS