Provider Demographics
NPI:1407012958
Name:MOTALA, SURAIYA
Entity Type:Individual
Prefix:
First Name:SURAIYA
Middle Name:
Last Name:MOTALA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20215 VILLAGE GREEN DR
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90715-1010
Mailing Address - Country:US
Mailing Address - Phone:562-860-4114
Mailing Address - Fax:
Practice Address - Street 1:20215 VILLAGE GREEN DR
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90715-1010
Practice Address - Country:US
Practice Address - Phone:562-860-4114
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-04
Last Update Date:2008-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program