Provider Demographics
NPI:1346041340
Name:POTTS, ELIZA KAY
Entity type:Individual
Prefix:
First Name:ELIZA
Middle Name:KAY
Last Name:POTTS
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 W LA VETA AVE # D29
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92866-2600
Mailing Address - Country:US
Mailing Address - Phone:408-533-5639
Mailing Address - Fax:
Practice Address - Street 1:12395 LEWIS ST STE 102
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92840-4698
Practice Address - Country:US
Practice Address - Phone:760-815-5815
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-24
Last Update Date:2025-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty