Healthcare Provider Details

I. General information

NPI: 1245729128
Provider Name (Legal Business Name): SEETHAL MOTAMARRI DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2018
Last Update Date: 07/16/2025
Certification Date: 07/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 SUPERIOR AVE
NEWPORT BEACH CA
92663-3663
US

IV. Provider business mailing address

3231 EUCLID AVE FL 5
BERWYN IL
60402-4603
US

V. Phone/Fax

Practice location:
  • Phone: 949-791-3001
  • Fax: 949-791-3096
Mailing address:
  • Phone: 708-783-2000
  • Fax: 708-783-3656

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number125.073017
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207QS1201X
TaxonomySleep Medicine (Family Medicine) Physician
License Number036.157018
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207RS0010X
TaxonomySports Medicine (Internal Medicine) Physician
License Number20399
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: