Healthcare Provider Details

I. General information

NPI: 1699960666
Provider Name (Legal Business Name): GORDANA POTREBIC PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/12/2007
Last Update Date: 04/24/2026
Certification Date: 04/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 TAMAL PLZ STE 220
CORTE MADERA CA
94925-1136
US

IV. Provider business mailing address

1500 VALLEY HOUSE DR STE 210
ROHNERT PARK CA
94928-4938
US

V. Phone/Fax

Practice location:
  • Phone: 707-478-5689
  • Fax:
Mailing address:
  • Phone: 707-478-5689
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY27343
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: