Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | G70733 | CA |
NPI | 1013977768 |
---|---|
Provider Name | Michael Leslee Potruch |
First Address | Mission Hills, CA 91345-1225 |
Second Address | Mission Hills, CA 91345-1225 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/03/2006 |
Last Update Date | 27/12/2012 |