Provider Demographics
NPI:1508881509
Name:MOTTALEI, FARAMARZ (MD)
Entity Type:Individual
Prefix:
First Name:FARAMARZ
Middle Name:
Last Name:MOTTALEI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 11359
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CA
Mailing Address - Zip Code:92685-1359
Mailing Address - Country:US
Mailing Address - Phone:800-665-5712
Mailing Address - Fax:
Practice Address - Street 1:1000 TRANCAS STREET
Practice Address - Street 2:
Practice Address - City:NAPA
Practice Address - State:CA
Practice Address - Zip Code:94558
Practice Address - Country:US
Practice Address - Phone:707-257-4014
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2008-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA53091207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A530910Medicaid
G35513Medicare UPIN
CA00A530912Medicare Oscar/Certification
CA00A530912Medicare PIN