Provider Demographics
NPI:1295252179
Name:MEHRAN MOTAMED, MD, PC
Entity type:Organization
Organization Name:MEHRAN MOTAMED, MD, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MEHRAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MOTAMED
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-551-1378
Mailing Address - Street 1:29650 EASTBANK DR
Mailing Address - Street 2:
Mailing Address - City:SUN CITY
Mailing Address - State:CA
Mailing Address - Zip Code:92585-9076
Mailing Address - Country:US
Mailing Address - Phone:718-551-1278
Mailing Address - Fax:
Practice Address - Street 1:28078 BAXTER RD STE 230
Practice Address - Street 2:
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92563-1403
Practice Address - Country:US
Practice Address - Phone:718-551-1378
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-23
Last Update Date:2017-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA898512084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Single Specialty