MEDICARE: JAFAR MOTTAGHIAN MONAZZAM

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	225100000X	Physical Therapist	PT18908	CA

General Provider Information

NPI Number	:	1942361753
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JAFAR MOTTAGHIAN MONAZZAM

Provider Business Mailing Address
First Line	:	4067 TWEEDY BL
Second Line	:
City	:	SOUTH GATE
State	:	CA
Zip	:	90280-6146
Country	:	US
Telephone Number	:	323-563-1160
Fax Number	:	323-563-1169

Provider Business Practice Location Address
First Line	:	4067 TWEEDY BL
Second Line	:
City	:	SOUTH GATE
State	:	CA
Zip	:	90280-6146
Country	:	US
Telephone Number	:	323-563-1160
Fax Number	:	323-563-1169

Authorized Official
Title or Position	:	OWNER DIRECTOR
Name	:	MR. JAFAR MOTTAGHIAN MONAZZAM
Credential	:	PT
Telephone Number	:	323-563-1160

Provider Enumeration Date	:	12/13/2006
Last Update Date	:	04/18/2013

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