Provider Demographics
NPI:1932848991
Name:MBLDN PSYCHIATRY
Entity Type:Organization
Organization Name:MBLDN PSYCHIATRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:MOTAKEF
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:951-201-1453
Mailing Address - Street 1:500 S ANAHEIM HILLS RD STE 246
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92807-4760
Mailing Address - Country:US
Mailing Address - Phone:949-414-9495
Mailing Address - Fax:
Practice Address - Street 1:500 S ANAHEIM HILLS RD STE 246
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92807-4760
Practice Address - Country:US
Practice Address - Phone:949-414-9495
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-28
Last Update Date:2022-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health