Jafar Mottaghian Monazzam

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT18908 Issued in CA

Legal business name

JAFAR MOTTAGHIAN MONAZZAM

Doing business as

South Gate Physical Therapy

Practice address

4067 Tweedy BL
South Gate, CA 90280-6146

Phone

(323) 563-1160

Fax

(323) 563-1169

NPI assigned

Dec 13, 2006

Organization subpart

No

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

Authorized official

Name

Mr. Jafar Mottaghian Monazzam, PTNPI 1609987007

Title

Owner Director

Phone

(323) 563-1160

Specialties & licenses 1

Addresses

Other names 1

• South Gate Physical Therapy Doing business as

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Outpatient physical therapy / speech pathology certification: CCN 056719

Legal name

SOUTH GATE PT SPORTS MEDICINE CENTER

Certification status

Active

Provider type (POS)

Outpatient physical therapy / speech pathology

Participating since

Nov 2, 1994

Last certification

Sep 5, 2018

Ownership / control type

Proprietary

Facility address

4067 Tweedy Blvd Suite B
South Gate, CA 90280

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Jafar Mottaghian Monazzam, PT

  • Physical Therapist
  • South Gate, CA
  • NPI 1609987007
  NPD Authorized official

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

{
    "created_epoch": "1165968000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1366243200000",
    "number": "1942361753",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4067 TWEEDY BL",
            "city": "SOUTH GATE",
            "state": "CA",
            "postal_code": "902806146",
            "telephone_number": "323-563-1160",
            "fax_number": "323-563-1169"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4067 TWEEDY BL",
            "city": "SOUTH GATE",
            "state": "CA",
            "postal_code": "902806146",
            "telephone_number": "323-563-1160",
            "fax_number": "323-563-1169"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JAFAR MOTTAGHIAN MONAZZAM",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-13",
        "last_updated": "2013-04-18",
        "status": "A",
        "authorized_official_last_name": "MONAZZAM",
        "authorized_official_first_name": "JAFAR",
        "authorized_official_middle_name": "MOTTAGHIAN",
        "authorized_official_title_or_position": "OWNER DIRECTOR",
        "authorized_official_telephone_number": "323-563-1160",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": "CA",
            "license": "PT18908",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "South Gate Physical Therapy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Physical Therapist in South Gate, CA
• Providers in South Gate, CA by specialty
• Physical Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 18, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.