Amir Hossein Mortazavientesab, M.D.

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

A166476 Issued in CA

Practice address

78120 Wildcat Dr
Palm Desert, CA 92211-1140

Phone

(760) 340-2682

Fax

(760) 773-9695

NPI assigned

Feb 14, 2017

Last updated

Jul 9, 2020By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other names 1

• Dr. Amir Mortazavi Professional name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1487030400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1594252800000",
    "number": "1073052791",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "78120 WILDCAT DR",
            "city": "PALM DESERT",
            "state": "CA",
            "postal_code": "922111140",
            "telephone_number": "760-340-2682",
            "fax_number": "760-773-9695"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "78120 WILDCAT DR",
            "city": "PALM DESERT",
            "state": "CA",
            "postal_code": "922111140",
            "telephone_number": "760-340-2682",
            "fax_number": "760-773-9695"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MORTAZAVIENTESAB",
        "first_name": "AMIR HOSSEIN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-02-14",
        "last_updated": "2020-07-09",
        "certification_date": "2020-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "A166476",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "AMIR",
            "last_name": "MORTAZAVI",
            "prefix": "DR.",
            "credential": "M.D.",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

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• Corina Lynn Morrison, DC
• Joseph Edward Morrow Jr., PSY.D.
• Negeene Mosaed, PT
• Michael Mostyn, M.D.
• Luis A. Moya, D.D.S
• Debi Ann Muir
• Vanessa Mullen, AMFT

• Internal Medicine Physician in Palm Desert, CA
• Providers in Palm Desert, CA by specialty
• Internal Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.