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General NPI Number Information
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NPI Number | 1811709991
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Entity Type | Organization
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Legal Business Name | MBLDN TMS PC
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Dates
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Enumeration Date | 01/24/2025
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Last Update Date | 06/16/2025
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Provider Practice Location Address
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Address Line | 21580 YORBA LINDA BLVD STE B
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City | YORBA LINDA
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State | CA
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Zip | 92887-3748
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Country | US
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Telephone | 949-414-9495
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Fax | 949-593-0312
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Provider Business Mailing Address
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Address Line | 21580 YORBA LINDA BLVD STE B
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City | YORBA LINDA
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State | CA
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Zip | 92887-3748
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Country | US
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Telephone | 949-414-9495
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | NICOLE MOTAKEF
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Credential | DO
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Telephone | 949-414-9495
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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