Provider Demographics
NPI:1568887149
Name:MOTWANI, MANOJ (MD)
Entity Type:Individual
Prefix:DR
First Name:MANOJ
Middle Name:
Last Name:MOTWANI
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 1:4520 EXECUTIVE DR
Mailing Address - Street 2:SUITE 230
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92121-3018
Mailing Address - Country:US
Mailing Address - Phone:858-554-0008
Mailing Address - Fax:
Practice Address - Street 1:4520 EXECUTIVE DR
Practice Address - Street 2:SUITE 230
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121-3018
Practice Address - Country:US
Practice Address - Phone:858-554-0008
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-19
Last Update Date:2014-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA69391207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
676288Medicare UPIN