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General NPI Number Information
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NPI Number | 1780393314
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Entity Type | Individual
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Provider Name | CHANDRA SEKHAR POTNURU
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Gender | Male
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Dates
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Enumeration Date | 11/22/2022
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Last Update Date | 01/27/2025
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Provider Practice Location Address
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Address Line | 225 30TH ST STE 311
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City | SACRAMENTO
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State | CA
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Zip | 95816-3359
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Country | US
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Telephone | 916-870-8586
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Fax | 916-236-3639
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Provider Business Mailing Address
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Address Line | 9146 E STOCKTON BLVD # 1039
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City | ELK GROVE
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State | CA
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Zip | 95624-9510
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Country | US
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Telephone | 916-870-8586
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Fax | 916-236-3639
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | LMFT152323
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License Number State | CA
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