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General NPI Number Information
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NPI Number | 1518056977
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Entity Type | Organization
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Legal Business Name | MOTAMEDI & MODARRESI A PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 10/12/2006
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Last Update Date | 04/10/2012
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Provider Practice Location Address
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Address Line | 11600 WILSHIRE BLVD SUITE 508
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City | LOS ANGELES
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State | CA
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Zip | 90025-5781
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Country | US
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Telephone | 316-575-9995
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Fax | 310-575-6665
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Provider Business Mailing Address
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Address Line | PO BOX 3519
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City | SANTA MONICA
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State | CA
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Zip | 90408-3519
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Country | US
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Telephone | 310-575-9995
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Fax | 310-575-6665
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Authorized Official
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Title or Position | PRESIDENT
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Name | FARHAD MOTAMEDI
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Credential | MD
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Telephone | 310-575-9995
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number | A39018
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License Number State | CA
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