MEDICARE: DR. ALI REZA MOTAMEDI 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	207XX0005X	Sports Medicine (Orthopaedic Surgery) Physician	A68501	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	M6783	OTHER	TX	STATE LICENSE
2	A68501	OTHER	CA	STATE LICENSE

General Provider Information

NPI Number	:	1295801744
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALI REZA MOTAMEDI M.D.

Provider Business Mailing Address
First Line	:	1203 FLYNN RD UNIT 160
Second Line	:
City	:	CAMARILLO
State	:	CA
Zip	:	93012-6203
Country	:	US
Telephone Number	:	805-804-4168
Fax Number	:	805-830-1177

Provider Business Practice Location Address
First Line	:	3901 LAS POSAS RD STE 4
Second Line	:
City	:	CAMARILLO
State	:	CA
Zip	:	93010-1502
Country	:	US
Telephone Number	:	805-585-5166
Fax Number	:	805-383-1768

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

Provider Enumeration Date	:	11/27/2006
Last Update Date	:	01/20/2026

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