Provider Demographics
NPI:1659820298
Name:JEREMY LA MOTTE MD
Entity Type:Organization
Organization Name:JEREMY LA MOTTE MD
Other - Org Name:STARWEST MEDICAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SOLE OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEREMY
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:LAMOTTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-218-3001
Mailing Address - Street 1:24953 PASEO DE VALENCIA STE 10B
Mailing Address - Street 2:
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-4340
Mailing Address - Country:US
Mailing Address - Phone:949-900-2393
Mailing Address - Fax:949-900-2394
Practice Address - Street 1:24953 PASEO DE VALENCIA BLDG B
Practice Address - Street 2:
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-4342
Practice Address - Country:US
Practice Address - Phone:949-900-2393
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-23
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty