Provider Demographics
NPI:1083983944
Name:E&T BEHAVIORAL ADVISORY
Entity Type:Organization
Organization Name:E&T BEHAVIORAL ADVISORY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHIATRIST
Authorized Official - Prefix:
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 1:31086 LARCHWOOD ST
Mailing Address - Street 2:
Mailing Address - City:MENIFEE
Mailing Address - State:CA
Mailing Address - Zip Code:92584-8702
Mailing Address - Country:US
Mailing Address - Phone:718-551-1378
Mailing Address - Fax:718-551-1378
Practice Address - Street 1:950 N RAMONA BLVD
Practice Address - Street 2:SUITE 2
Practice Address - City:SAN JACINTO
Practice Address - State:CA
Practice Address - Zip Code:92582-2567
Practice Address - Country:US
Practice Address - Phone:718-551-1378
Practice Address - Fax:951-487-2679
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-22
Last Update Date:2016-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA898512084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Single Specialty