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NPI Code Detail

MEDICARE: MRS. CYNTHIA POTTER RBT

MEDICARE: MRS. CYNTHIA POTTER RBT
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 TechnicianRBT-17-45863AK

General Provider Information

NPI Number : 1679089601
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. CYNTHIA POTTER RBT
Provider Business Mailing Address
First Line : 1055 E COLORADO BLVD STE 5602
Second Line :
City : PASADENA
State : CA
Zip : 91106-2327
Country : US
Telephone Number : 818-241-6780
Fax Number :
Provider Business Practice Location Address
First Line : 5400 SUNCREST DR STE D1
Second Line :
City : EL PASO
State : TX
Zip : 79912-5615
Country : US
Telephone Number : 818-241-6780
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/28/2017
Last Update Date : 09/19/2019

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