Individual provider Active NPI

Jamie Lynn Kostialik, MS, CGC

  • Genetic Counselor (M.S.)
  • Los Angeles, CA
National Provider Identifier
1730451006
Registry record updated Feb 2, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Genetic Counselor (M.S.)Taxonomy code 170300000X
License
ABGC:15738 Issued in CA
Practice address
5300 McConnell Ave
Los Angeles, CA 90066
Phone
(310) 482-5637
Fax
(310) 482-5600
NPI assigned
Feb 2, 2012
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 2, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Genetic Counselor (M.S.) 170300000X ABGC:15738 CA Primary

Addresses

Primary practice location

5300 McConnell Ave
Los Angeles, CA 90066

Mailing address

5300 McConnell Ave
Los Angeles, CA 90066
Phone (310) 482-5637

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Master of Science

State licenses

LicenseStateTypeSpecialty
ABGC:15738CAMDGenetic Counselor (M.S.)

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1328140800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1328140800000",
    "number": "1730451006",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5300 MCCONNELL AVE",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "90066",
            "telephone_number": "310-482-5637",
            "fax_number": "310-482-5600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5300 MCCONNELL AVE",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "90066",
            "telephone_number": "310-482-5637",
            "fax_number": "310-482-5600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOSTIALIK",
        "first_name": "JAMIE",
        "middle_name": "LYNN",
        "name_prefix": "Ms.",
        "credential": "MS, CGC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-02-02",
        "last_updated": "2012-02-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "170300000X",
            "taxonomy_group": "",
            "desc": "Genetic Counselor, MS",
            "state": "CA",
            "license": "ABGC:15738",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Los Angeles, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 2, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.