MEDICARE: BRENDA MARIE POTTS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	15304	CA

General Provider Information

NPI Number	:	1134073968
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRENDA MARIE POTTS

Provider Business Mailing Address
First Line	:	7671 MISSION GORGE RD UNIT 102
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92120-1360
Country	:	US
Telephone Number	:	619-362-4100
Fax Number	:	619-362-4149

Provider Business Practice Location Address
First Line	:	1844 S 40TH ST
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92113-4099
Country	:	US
Telephone Number	:	619-362-4100
Fax Number	:	619-362-4149

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/26/2026
Last Update Date	:	03/18/2026

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Directions to “ BRENDA MARIE POTTS ” Practice Location

Language	Start Address	Practice Location

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