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NPI Code Detail

MEDICARE: REENA POTILLOR

MEDICARE: REENA POTILLOR
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
1183700000XPharmacy Technician67924CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1356017891
Entity Type Code : Individual
Provider Name (Legal Business Name) : REENA POTILLOR
Provider Business Mailing Address
First Line : 2751 DEL PASO RD
Second Line :
City : SACRAMENTO
State : CA
Zip : 95835-2303
Country : US
Telephone Number : 916-285-9372
Fax Number :
Provider Business Practice Location Address
First Line : 2751 DEL PASO RD
Second Line :
City : SACRAMENTO
State : CA
Zip : 95835-2303
Country : US
Telephone Number : 916-285-9372
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/16/2021
Last Update Date : 08/16/2021

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Directions to “ REENA POTILLOR ” Practice Location

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