Healthcare Provider Details

I. General information

NPI: 1780875799
Provider Name (Legal Business Name): CELESTE E POTTORFF D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2007
Last Update Date: 03/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1661 E CAMELBACK RD SUITE 160
PHOENIX AZ
85016-3911
US

IV. Provider business mailing address

1661 E CAMELBACK RD SUITE 160
PHOENIX AZ
85016-3911
US

V. Phone/Fax

Practice location:
  • Phone: 602-241-1671
  • Fax: 602-274-6181
Mailing address:
  • Phone: 602-241-1671
  • Fax: 602-274-6181

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberR1087
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number005675
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: