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NPI Code Detail

MEDICARE: MICHAEL PATRICK POTTER MASTERS

MEDICARE: MICHAEL PATRICK POTTER MASTERS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106S00000XBehavior Technician20-111005CA

General Provider Information

NPI Number : 1306534789
Entity Type Code : Individual
Provider Name (Legal Business Name) : MICHAEL PATRICK POTTER MASTERS
Provider Business Mailing Address
First Line : 119 W TORRANCE BLVD
Second Line :
City : REDONDO BEACH
State : CA
Zip : 90277-3600
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 5741 LAS VIRGENES RD
Second Line :
City : CALABASAS
State : CA
Zip : 91302-1272
Country : US
Telephone Number : 818-712-8255
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/25/2023
Last Update Date : 04/25/2023

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Directions to “ MICHAEL PATRICK POTTER MASTERS” Practice Location

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