Individual provider Active NPI

Dawn Angel Mottola, PT

  • Licensed Psychiatric Technician
  • Azusa, CA
National Provider Identifier
1568112605
Registry record updated Mar 23, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Licensed Psychiatric TechnicianTaxonomy code 167G00000X
License
PT29554 Issued in CA
Practice address
23701 E East Fork Rd
Azusa, CA 91702-1477
Phone
(626) 625-3291
NPI assigned
Mar 23, 2022
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 23, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Licensed Psychiatric Technician 167G00000X PT29554 CA Primary

Addresses

Primary practice location

23701 E East Fork Rd
Azusa, CA 91702-1477

Mailing address

23701 E East Fork Rd
Azusa, CA 91702-1477
Phone (626) 625-3291

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

NPI Registry JSON

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

{
    "created_epoch": "1647993600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1647993600000",
    "number": "1568112605",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "23701 E EAST FORK RD",
            "city": "AZUSA",
            "state": "CA",
            "postal_code": "917021477",
            "telephone_number": "626-625-3291"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "23701 E EAST FORK RD",
            "city": "AZUSA",
            "state": "CA",
            "postal_code": "917021477",
            "telephone_number": "626-625-3291"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOTTOLA",
        "first_name": "DAWN",
        "middle_name": "ANGEL",
        "credential": "PT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-03-23",
        "last_updated": "2022-03-23",
        "certification_date": "2022-03-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "167G00000X",
            "taxonomy_group": "",
            "desc": "Licensed Psychiatric Technician",
            "state": "CA",
            "license": "PT29554",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Azusa, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 23, 2022; 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.