Provider Demographics
NPI:1871970129
Name:MOTTA, PETER
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:
Last Name:MOTTA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5220 W WASHINGTON BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90016-1331
Mailing Address - Country:US
Mailing Address - Phone:310-478-8305
Mailing Address - Fax:310-478-8639
Practice Address - Street 1:5220 W WASHINGTON BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90016-1331
Practice Address - Country:US
Practice Address - Phone:323-938-8184
Practice Address - Fax:323-933-9186
Is Sole Proprietor?:No
Enumeration Date:2015-05-06
Last Update Date:2015-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)