Healthcare Provider Details

I. General information

NPI: 1457114993
Provider Name (Legal Business Name): MOTI MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2024
Last Update Date: 05/19/2025
Certification Date: 05/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

518 W EATON AVE
TRACY CA
95376-3422
US

IV. Provider business mailing address

518 W EATON AVE
TRACY CA
95376-3422
US

V. Phone/Fax

Practice location:
  • Phone: 209-833-2228
  • Fax:
Mailing address:
  • Phone: 209-833-2228
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: OMAIRAH MOTI
Title or Position: PRESIDENT
Credential: MD
Phone: 209-833-2228