Provider Demographics
NPI:1508949546
Name:MOTAYAR, MAHNAZ (PHD)
Entity Type:Individual
Prefix:DR
First Name:MAHNAZ
Middle Name:
Last Name:MOTAYAR
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14125 CAPRI DR STE 3
Mailing Address - Street 2:
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95032-1516
Mailing Address - Country:US
Mailing Address - Phone:408-314-6944
Mailing Address - Fax:408-866-0303
Practice Address - Street 1:14125 CAPRI DR STE 3
Practice Address - Street 2:
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95032-1516
Practice Address - Country:US
Practice Address - Phone:408-314-6944
Practice Address - Fax:408-866-0303
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2013-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY19942103G00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOPL199421Medicare ID - Type Unspecified