Provider Demographics
NPI:1932211067
Name:MOTAMEDI, SHAHLA MODARRESI (MD)
Entity Type:Individual
Prefix:DR
First Name:SHAHLA
Middle Name:MODARRESI
Last Name:MOTAMEDI
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:326 GEORGINA AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90402-1618
Mailing Address - Country:US
Mailing Address - Phone:310-458-0050
Mailing Address - Fax:310-575-6665
Practice Address - Street 1:11301 WILSHIRE BLVD
Practice Address - Street 2:WEST LA V.A. HOSPITAL.,IMAGING DEPT.,BLDG 500,ROOM 0608
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90073-1003
Practice Address - Country:US
Practice Address - Phone:310-268-3591
Practice Address - Fax:310-575-6665
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA413822085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology