Healthcare Provider Details

I. General information

NPI: 1003867698
Provider Name (Legal Business Name): MANUEL RAMON MOTA-CASTILLO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: MANUEL R MOTA MD

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 08/13/2025
Certification Date: 08/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1225 W 190TH ST STE 280
GARDENA CA
90248-4305
US

IV. Provider business mailing address

1225 W 190TH ST STE 280
GARDENA CA
90248-4305
US

V. Phone/Fax

Practice location:
  • Phone: 877-515-8113
  • Fax: 877-538-2102
Mailing address:
  • Phone: 877-515-8113
  • Fax: 877-538-2102

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number154305
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberME82747
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: