Provider Demographics
NPI:1932391273
Name:POTVIN, GREG L (LACP)
Entity Type:Individual
Prefix:
First Name:GREG
Middle Name:L
Last Name:POTVIN
Suffix:
Gender:M
Credentials:LACP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27762 FORBES RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:LAGUNA NIGUEL
Mailing Address - State:CA
Mailing Address - Zip Code:92677-1203
Mailing Address - Country:US
Mailing Address - Phone:949-582-7957
Mailing Address - Fax:949-582-7139
Practice Address - Street 1:27762 FORBES RD
Practice Address - Street 2:SUITE 1
Practice Address - City:LAGUNA NIGUEL
Practice Address - State:CA
Practice Address - Zip Code:92677-1203
Practice Address - Country:US
Practice Address - Phone:949-582-7957
Practice Address - Fax:949-582-7139
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-10
Last Update Date:2007-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA4637171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist