Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LW0102X | Nurse Practitioner - Women's Health | 95000414 | CA |
NPI | 1043753353 |
---|---|
Provider Name | Ms. Candita Potts |
First Address | Long Beach, CA 90809 |
Second Address | Lynwood, CA 90262-2643 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/11/2016 |
Last Update Date | 06/09/2017 |