Provider Demographics
NPI:1508836610
Name:KALLA, KRISTIN A (MS, CGC)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:A
Last Name:KALLA
Suffix:
Gender:F
Credentials:MS, CGC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9888 GENESEE AVE # LJ34
Mailing Address - Street 2:
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-1205
Mailing Address - Country:US
Mailing Address - Phone:858-626-4810
Mailing Address - Fax:858-626-4814
Practice Address - Street 1:9888 GENESEE AVE # LJ34
Practice Address - Street 2:
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-1205
Practice Address - Country:US
Practice Address - Phone:858-626-4810
Practice Address - Fax:858-626-4814
Is Sole Proprietor?:No
Enumeration Date:2006-01-23
Last Update Date:2010-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA170300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS