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NPI Code Detail

MEDICARE: MR. JOSE RICARDO MOTTOS LCSW

MEDICARE: MR. JOSE RICARDO MOTTOS LCSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker70797CA

General Provider Information

NPI Number : 1528375235
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. JOSE RICARDO MOTTOS LCSW
Provider Business Mailing Address
First Line : 427 ENCINAL CANYON RD
Second Line :
City : MALIBU
State : CA
Zip : 90265-2404
Country : US
Telephone Number : 818-735-2805
Fax Number :
Provider Business Practice Location Address
First Line : 427 ENCINAL CANYON RD
Second Line :
City : MALIBU
State : CA
Zip : 90265-2404
Country : US
Telephone Number : 818-735-2805
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/02/2010
Last Update Date : 04/25/2021

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