Healthcare Provider Details

I. General information

NPI: 1316299084
Provider Name (Legal Business Name): RACHEL CAROL POTENS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: RACHEL CAROL TRUE

II. Dates (important events)

Enumeration Date: 10/05/2012
Last Update Date: 10/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 THE ALAMEDA
SAN JOSE CA
95126-1136
US

IV. Provider business mailing address

1970 HARRIS AVE APT. B
SAN JOSE CA
95124-1018
US

V. Phone/Fax

Practice location:
  • Phone: 408-261-7777
  • Fax: 408-254-9960
Mailing address:
  • Phone: 305-975-7747
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: