Provider Demographics
NPI:1629496153
Name:MOTWANI, AYUSH PITU
Entity Type:Individual
Prefix:
First Name:AYUSH
Middle Name:PITU
Last Name:MOTWANI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3833 DUNN DR APT NO402
Mailing Address - Street 2:
Mailing Address - City:CULVER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90232-2795
Mailing Address - Country:US
Mailing Address - Phone:206-660-8977
Mailing Address - Fax:
Practice Address - Street 1:4955 VAN NUYS BLVD STE 308
Practice Address - Street 2:
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91403-1811
Practice Address - Country:US
Practice Address - Phone:818-558-3742
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-02
Last Update Date:2022-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA309679207R00000X
CAA177626207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine