Provider Demographics
NPI:1467023762
Name:CALONA, CINDY PORTILLO
Entity Type:Individual
Prefix:
First Name:CINDY
Middle Name:PORTILLO
Last Name:CALONA
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 1:225 W BROADWAY STE 155
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91204-1332
Mailing Address - Country:US
Mailing Address - Phone:818-333-8295
Mailing Address - Fax:818-662-6968
Practice Address - Street 1:601 S GLENOAKS BLVD STE 200
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91502-2787
Practice Address - Country:US
Practice Address - Phone:818-333-8595
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-07
Last Update Date:2023-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
No171M00000XOther Service ProvidersCase Manager/Care Coordinator