Provider Demographics
NPI:1447734371
Name:MOTAZEDIAN, MEHRNAZ
Entity Type:Individual
Prefix:
First Name:MEHRNAZ
Middle Name:
Last Name:MOTAZEDIAN
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 1:5519 KULA MAUU ST
Mailing Address - Street 2:
Mailing Address - City:KAPAA
Mailing Address - State:HI
Mailing Address - Zip Code:96746-2506
Mailing Address - Country:US
Mailing Address - Phone:310-775-3414
Mailing Address - Fax:
Practice Address - Street 1:5519 KULA MAUU
Practice Address - Street 2:
Practice Address - City:KAPAA
Practice Address - State:HI
Practice Address - Zip Code:96746
Practice Address - Country:US
Practice Address - Phone:310-775-3414
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-17
Last Update Date:2018-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst