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1851922702
MICHAEL POTENCIANO
VISTA, CA
NPI
1851922702
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
101YA0400X Counselor, Addiction (Substance Use Disorder)
Enumeration Date
2020-01-30
Last Update Date
2020-01-30
Business Address
MICHAEL POTENCIANO
1211 W VISTA WAY BLDG C
VISTA, CA 92083-6227
Phone number: 760-721-2781
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Mailing Address
MICHAEL POTENCIANO
1400 N JOHNSON AVE STE 101
EL CAJON, CA 92020-1651
Phone number:
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