Provider Demographics
NPI:1487769048
Name:CYNTHIA COLONE
Entity type:Organization
Organization Name:CYNTHIA COLONE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:YVETTE
Authorized Official - Last Name:COLONE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-331-3539
Mailing Address - Street 1:839 E SAN BERNARDINO RD
Mailing Address - Street 2:
Mailing Address - City:COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91723-1417
Mailing Address - Country:US
Mailing Address - Phone:626-331-3539
Mailing Address - Fax:
Practice Address - Street 1:839 E SAN BERNARDINO RD
Practice Address - Street 2:
Practice Address - City:COVINA
Practice Address - State:CA
Practice Address - Zip Code:91723-1417
Practice Address - Country:US
Practice Address - Phone:626-331-3539
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-21
Last Update Date:2008-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA46438332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA5935020001Medicare NSC