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General NPI Number Information
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NPI Number | 1134028087
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Entity Type | Individual
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Provider Name | MISS WILMER YVETTE POTTS
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Gender | Female
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Dates
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Enumeration Date | 11/05/2026
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Last Update Date | 11/05/2026
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Provider Practice Location Address
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Address Line | 3200 NAGLEE RD STE 190
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City | TRACY
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State | CA
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Zip | 95304-7329
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Country | US
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Telephone | 925-477-6945
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Fax |
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Provider Business Mailing Address
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Address Line | 667 W CORAZON WAY
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City | MOUNTAIN HOUSE
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State | CA
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Zip | 95391-2049
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Country | US
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Telephone | 925-477-6945
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number | 06024069
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License Number State | CA
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