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General NPI Number Information
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NPI Number | 1851024244
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Entity Type | Individual
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Provider Name | DANIELLE ANN POTH
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Gender | Female
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Dates
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Enumeration Date | 07/05/2022
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Last Update Date | 07/13/2023
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Provider Practice Location Address
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Address Line | 16516 BERNARDO CENTER DR STE 220
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City | SAN DIEGO
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State | CA
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Zip | 92128-2551
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Country | US
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Telephone | 858-336-2810
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Fax |
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Provider Business Mailing Address
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Address Line | 309 E 2ND ST
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City | POMONA
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State | CA
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Zip | 91766-1854
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Country | US
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Telephone |
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA61612
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License Number State | CA
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