Provider Demographics
NPI:1235681206
Name:MOTAMEDI, SANAZ (MFT)
Entity Type:Individual
Prefix:DR
First Name:SANAZ
Middle Name:
Last Name:MOTAMEDI
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4199 CAMPUS DR
Mailing Address - Street 2:SUITE 550
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92612-4684
Mailing Address - Country:US
Mailing Address - Phone:949-413-7140
Mailing Address - Fax:
Practice Address - Street 1:4199 CAMPUS DR
Practice Address - Street 2:SUITE 550
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92612-4684
Practice Address - Country:US
Practice Address - Phone:949-413-7140
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-26
Last Update Date:2016-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA48441106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist