Provider Demographics
NPI:1295801744
Name:MOTAMEDI, ALI REZA (MD)
Entity type:Individual
Prefix:DR
First Name:ALI
Middle Name:REZA
Last Name:MOTAMEDI
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 1:5720 RALSTON ST STE 200
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-7844
Mailing Address - Country:US
Mailing Address - Phone:805-804-4168
Mailing Address - Fax:805-830-1177
Practice Address - Street 1:3901 LAS POSAS RD STE 4
Practice Address - Street 2:
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93010-1502
Practice Address - Country:US
Practice Address - Phone:805-585-5166
Practice Address - Fax:805-383-1768
Is Sole Proprietor?:No
Enumeration Date:2006-11-27
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA68501207X00000X, 207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA68501OtherSTATE LICENSE
TXM6783OtherSTATE LICENSE
TXM6783OtherSTATE LICENSE
TX7745036OtherAETNA
TXP00953244OtherRAILROAD MEDICARE
TX214896703Medicaid
TXP01026662OtherRAILROAD MEDICARE
TX214896705Medicaid
TX8AD235OtherBCBS
CA1295801744OtherNPI
TX750813OtherBEECHSTREET
TXTXB143773Medicare PIN
TXTXB143774Medicare PIN
TX8L26323Medicare PIN
TXTXB143771Medicare PIN
TX214896702Medicaid
TX214896701Medicaid