Healthcare Provider Details

I. General information

NPI: 1770603870
Provider Name (Legal Business Name): MRS. VALERIE V POTRIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2901 MEADOWLARK DR
SAN DIEGO CA
92123
US

IV. Provider business mailing address

2901 MEADOWLARK DR 1ST FLOOR
SAN DIEGO CA
92123
US

V. Phone/Fax

Practice location:
  • Phone: 858-694-4752
  • Fax: 858-514-8425
Mailing address:
  • Phone: 858-694-4680
  • Fax: 858-694-4492

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN401536
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: