Provider Demographics
NPI:1235585886
Name:MOTTAGHI, JUSTIN (MD)
Entity Type:Individual
Prefix:
First Name:JUSTIN
Middle Name:
Last Name:MOTTAGHI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 603
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90801-0603
Mailing Address - Country:US
Mailing Address - Phone:213-283-8987
Mailing Address - Fax:612-446-5796
Practice Address - Street 1:3515 ATLANTIC AVE # 1183
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90807-4515
Practice Address - Country:US
Practice Address - Phone:213-283-8987
Practice Address - Fax:612-446-5796
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-12
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA158823207L00000X
MN67958207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology