Provider Demographics
NPI:1144370792
Name:POTRA-CIONCA, FLORICA (PA)
Entity type:Individual
Prefix:
First Name:FLORICA
Middle Name:
Last Name:POTRA-CIONCA
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2101 WILD CANYON DR
Mailing Address - Street 2:
Mailing Address - City:COLTON
Mailing Address - State:CA
Mailing Address - Zip Code:92324-9521
Mailing Address - Country:US
Mailing Address - Phone:909-433-0232
Mailing Address - Fax:
Practice Address - Street 1:1125 N MAGNOLIA AVE
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92801-2638
Practice Address - Country:US
Practice Address - Phone:714-484-1280
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA 18687363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant