Provider Demographics
NPI:1053945220
Name:POTES, MARIA VICTORIA VALDEZ (NP)
Entity type:Individual
Prefix:
First Name:MARIA VICTORIA
Middle Name:VALDEZ
Last Name:POTES
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:MARIA
Other - Middle Name:VICTORIA
Other - Last Name:POTES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12616 FIFTH AVE
Mailing Address - Street 2:
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92395-9700
Mailing Address - Country:US
Mailing Address - Phone:760-552-3146
Mailing Address - Fax:
Practice Address - Street 1:12616 FIFTH AVE
Practice Address - Street 2:
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92395-9700
Practice Address - Country:US
Practice Address - Phone:760-951-5938
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-26
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA676307163W00000X
CA95014311363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse