Provider Demographics
NPI:1164756011
Name:MIR-MOTAHARI, BARRY (MSW INTERN)
Entity Type:Individual
Prefix:
First Name:BARRY
Middle Name:
Last Name:MIR-MOTAHARI
Suffix:
Gender:M
Credentials:MSW INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:358 W ALAMEDA AVE
Mailing Address - Street 2:APT 20
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91506-3336
Mailing Address - Country:US
Mailing Address - Phone:818-398-7864
Mailing Address - Fax:
Practice Address - Street 1:358 W ALAMEDA AVE
Practice Address - Street 2:APT 20
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91506-3336
Practice Address - Country:US
Practice Address - Phone:818-398-7864
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-24
Last Update Date:2009-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program