Provider Demographics
NPI:1609987007
Name:MONAZZAM, JAFAR MOTTAGHIAN (PT)
Entity Type:Individual
Prefix:
First Name:JAFAR
Middle Name:MOTTAGHIAN
Last Name:MONAZZAM
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4067 TWEEDY BLVD
Mailing Address - Street 2:
Mailing Address - City:SOUTH GATE
Mailing Address - State:CA
Mailing Address - Zip Code:90280-6146
Mailing Address - Country:US
Mailing Address - Phone:323-563-1160
Mailing Address - Fax:323-563-1169
Practice Address - Street 1:4067 TWEEDY BLVD
Practice Address - Street 2:
Practice Address - City:SOUTH GATE
Practice Address - State:CA
Practice Address - Zip Code:90280-6146
Practice Address - Country:US
Practice Address - Phone:323-563-1160
Practice Address - Fax:323-563-1169
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT018908225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist