Provider Demographics
NPI:1770137499
Name:KOLBUSZEWSKA, ANNA
Entity type:Individual
Prefix:MISS
First Name:ANNA
Middle Name:
Last Name:KOLBUSZEWSKA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:655 E HUNTINGTON DR
Mailing Address - Street 2:
Mailing Address - City:MONROVIA
Mailing Address - State:CA
Mailing Address - Zip Code:91016-3636
Mailing Address - Country:US
Mailing Address - Phone:626-471-9922
Mailing Address - Fax:
Practice Address - Street 1:110 TAMPICO STE 100
Practice Address - Street 2:
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94598-2961
Practice Address - Country:US
Practice Address - Phone:925-891-9033
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-31
Last Update Date:2019-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAGC001159170300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS