Provider Demographics
NPI:1710736137
Name:MOTA, IRMA VANESSA
Entity type:Individual
Prefix:MS
First Name:IRMA
Middle Name:VANESSA
Last Name:MOTA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 10563
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91510-0563
Mailing Address - Country:US
Mailing Address - Phone:310-896-5244
Mailing Address - Fax:
Practice Address - Street 1:800 S VICTORY BLVD STE 106
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91502-2489
Practice Address - Country:US
Practice Address - Phone:213-604-4007
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-16
Last Update Date:2024-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA134505106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist