Provider Demographics
NPI:1609846526
Name:MESTRE, LIESL JOHNSON (MS)
Entity Type:Individual
Prefix:
First Name:LIESL
Middle Name:JOHNSON
Last Name:MESTRE
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 1:1348 STANISLAUS DR
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91913-1402
Mailing Address - Country:US
Mailing Address - Phone:619-397-5992
Mailing Address - Fax:
Practice Address - Street 1:RADY CHILDREN'S HOSPITAL AND HEALTH CENTER
Practice Address - Street 2:3020 CHILDREN'S WAY, MC 5031
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123
Practice Address - Country:US
Practice Address - Phone:858-966-5840
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS