Individual
DESTANI ROVINE POTASI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
351 E 6TH ST, LONG BEACH, CA 90802-1402
(310) 866-8453
Mailing address
17911 LA SALLE AVE, GARDENA, CA 90248-3604
(310) 866-8453
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
MPSS-GSDUMR
CA
175T00000X
Peer Specialist
—
—
Other
Enumeration date
04/22/2024
Last updated
05/27/2025
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