Healthcare Provider Details

I. General information

NPI: 1467023762
Provider Name (Legal Business Name): CINDY PORTILLO CALONA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2021
Last Update Date: 06/06/2023
Certification Date: 06/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 S GLENOAKS BLVD STE 200
BURBANK CA
91502-2787
US

IV. Provider business mailing address

225 W BROADWAY STE 155
GLENDALE CA
91204-1332
US

V. Phone/Fax

Practice location:
  • Phone: 818-333-8595
  • Fax:
Mailing address:
  • Phone: 818-333-8295
  • Fax: 818-662-6968

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: