MEDICARE: DR. MEHRAN MOTAMED M,D

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0804X	Child & Adolescent Psychiatry Physician	A89851	CA
2	2084P0800X	Psychiatry Physician	A89851	CA

General Provider Information

NPI Number	:	1053415182
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MEHRAN MOTAMED M,D

Provider Business Mailing Address
First Line	:	31086 LARCHWOOD ST
Second Line	:
City	:	MENIFEE
State	:	CA
Zip	:	92584-8702
Country	:	US
Telephone Number	:	718-551-1378
Fax Number	:

Provider Business Practice Location Address
First Line	:	950 N RAMONA BLVD
Second Line	:	SUITE 2
City	:	SAN JACINTO
State	:	CA
Zip	:	92582-2567
Country	:	US
Telephone Number	:	718-551-1378
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/11/2006
Last Update Date	:	11/02/2021

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