Healthcare Provider Details

I. General information

NPI: 1114867579
Provider Name (Legal Business Name): DANIEL MOTAMEDI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/28/2026
Last Update Date: 03/28/2026
Certification Date: 03/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26614 CAMPBELL CT
STEVENSON RANCH CA
91381-1444
US

IV. Provider business mailing address

26614 CAMPBELL CT
STEVENSON RANCH CA
91381-1444
US

V. Phone/Fax

Practice location:
  • Phone: 661-745-6666
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: