Individual
JACQUELINE M POTOKAR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CERTIFIED CARE GIVER
Contact information
Practice address
5175 S KINGS RANCH RD, GOLD CANYON, AZ 85118-3337
(602) 708-0546
Mailing address
5175 S KINGS RANCH RD, GOLD CANYON, AZ 85118-3337
(602) 708-0546
Taxonomy
Speciality
Code
Description
License number
State
372600000X
Adult Companion
Primary
ALTP0141
AZ
Other
Enumeration date
04/24/2010
Last updated
04/24/2010
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