| Doctor Name: | MRS. CRISTINA A PORTILLO-VIA |
| NPI Number: | 1679845226 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LCSW |
| License Number: | 36748 |
| Business Practice Address: | 3049 Montrose Ave La Crescenta, CA - 912143659 |
| Business Phone Number: | 2147346664 |
| Business Fax Number: | |
| Mailing Address: | Po Box 8003, LA CRESCENTA |
| State: | CA |
| Postal Code: | 912240003 |
| Phone Number: | 2147346664 |
| Fax Number: | |
| NPI Enumeration Date: | 01/28/2012 |
| NPI Last Update Date: | 01/28/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | 36748 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | TX |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |