Provider Demographics
NPI:1669964805
Name:FIRESTONE, KYRA MICHELLE (MS, LCGC)
Entity type:Individual
Prefix:
First Name:KYRA
Middle Name:MICHELLE
Last Name:FIRESTONE
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 1:4011 LAMONT ST UNIT 3A
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92109-6229
Mailing Address - Country:US
Mailing Address - Phone:310-961-6756
Mailing Address - Fax:
Practice Address - Street 1:9834 GENESEE AVE STE 128
Practice Address - Street 2:
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-1214
Practice Address - Country:US
Practice Address - Phone:858-824-5048
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-04
Last Update Date:2021-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAGC000992170300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS