Individual
ANGELA POTTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PSS
Contact information
Practice address
3125 MYERS ST, RIVERSIDE, CA 92503-5527
(951) 358-5862
Mailing address
3125 MYERS ST, RIVERSIDE, CA 92503-5527
(951) 358-5862
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1487716619
—
CA
Enumeration date
02/07/2023
Last updated
09/02/2025
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