Provider Demographics
NPI:1568695104
Name:MOTAN, RIYAZ (MFT)
Entity Type:Individual
Prefix:MR
First Name:RIYAZ
Middle Name:
Last Name:MOTAN
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:MR
Other - First Name:RIYAZ
Other - Middle Name:TAJDIEEN
Other - Last Name:MOTAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MFT
Mailing Address - Street 1:1634 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94901-1809
Mailing Address - Country:US
Mailing Address - Phone:415-460-9009
Mailing Address - Fax:
Practice Address - Street 1:1634 5TH AVE
Practice Address - Street 2:
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94901-1809
Practice Address - Country:US
Practice Address - Phone:415-460-9009
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-31
Last Update Date:2009-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA37451106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist