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General NPI Number Information
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NPI Number | 1295252179
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Entity Type | Organization
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Legal Business Name | MEHRAN MOTAMED, MD, PC
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Dates
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Enumeration Date | 08/23/2017
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Last Update Date | 10/30/2017
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Provider Practice Location Address
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Address Line | 28078 BAXTER RD STE 230
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City | MURRIETA
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State | CA
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Zip | 92563-1403
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Country | US
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Telephone | 718-551-1378
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Fax |
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Provider Business Mailing Address
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Address Line | 29650 EASTBANK DR
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City | SUN CITY
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State | CA
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Zip | 92585-9076
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Country | US
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Telephone | 718-551-1278
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MEHRAN MOTAMED
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Credential | MD
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Telephone | 718-551-1378
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number | A89851
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License Number State | CA
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