Basic Information
| Provider Information | |||||||||
| NPI: | 1083983944 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | E&T BEHAVIORAL ADVISORY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 31086 LARCHWOOD ST | ||||||||
| Address2: | |||||||||
| City: | MENIFEE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 925848702 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7185511378 | ||||||||
| FaxNumber: | 7185511378 | ||||||||
| Practice Location | |||||||||
| Address1: | 950 N RAMONA BLVD | ||||||||
| Address2: | SUITE 2 | ||||||||
| City: | SAN JACINTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 925822567 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7185511378 | ||||||||
| FaxNumber: | 9514872679 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/22/2011 | ||||||||
| LastUpdateDate: | 12/09/2016 | ||||||||
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| AuthorizedOfficialLastName: | MOTAMED | ||||||||
| AuthorizedOfficialFirstName: | MEHRAN | ||||||||
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| AuthorizedOfficialTitleorPosition: | PSYCHIATRIST | ||||||||
| AuthorizedOfficialTelephone: | 7185511378 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0804X | A89851 | CA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Child & Adolescent Psychiatry |
No ID Information.