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NPI Code Detail

MEDICARE: SHALA MOTAMED P.T.

MEDICARE:   SHALA  MOTAMED  P.T.
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
1208100000XPhysical Medicine & Rehabilitation PhysicianPT14153CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1PT14153OTHERCAMEDICAL LICENSE

General Provider Information

NPI Number : 1215252598
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHALA MOTAMED P.T.
Provider Business Mailing Address
First Line : 20969 VENTURA BLVD
Second Line : 23
City : WOODLAND HILLS
State : CA
Zip : 91364-2305
Country : US
Telephone Number : 818-992-5252
Fax Number : 818-992-5292
Provider Business Practice Location Address
First Line : 20969 VENTURA BLVD
Second Line : 23
City : WOODLAND HILLS
State : CA
Zip : 91364-2305
Country : US
Telephone Number : 818-992-5252
Fax Number : 818-992-5292
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/30/2010
Last Update Date : 03/30/2010

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Directions to “ SHALA MOTAMED P.T.” Practice Location

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