Healthcare Provider Details

I. General information

NPI: 1598694184
Provider Name (Legal Business Name): MAZDA MOTALLEBI MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2026
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3737 MARTIN LUTHER KING JR BLVD STE 401
LYNWOOD CA
90262-3534
US

IV. Provider business mailing address

PO BOX 66657
SEATTLE WA
98166-0657
US

V. Phone/Fax

Practice location:
  • Phone: 310-604-0443
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number
License Number State

VIII. Authorized Official

Name: MAZDA MOTALLEBI
Title or Position: OWNER
Credential: MD
Phone: 310-913-1169