Healthcare Provider Details

I. General information

NPI: 1245889062
Provider Name (Legal Business Name): CINDY COLON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/04/2019
Last Update Date: 08/03/2023
Certification Date: 08/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11601 S WESTERN AVE
LOS ANGELES CA
90047-5006
US

IV. Provider business mailing address

11601 S WESTERN AVE
LOS ANGELES CA
90047-5006
US

V. Phone/Fax

Practice location:
  • Phone: 323-242-5000
  • Fax:
Mailing address:
  • Phone: 323-242-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number97408
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: