Healthcare Provider Details

I. General information

NPI: 1679141477
Provider Name (Legal Business Name): ELLIE MEHRDEL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2021
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 OCEANGATE STE 100
LONG BEACH CA
90802-4317
US

IV. Provider business mailing address

3857 BIRCH ST STE 3211
NEWPORT BEACH CA
92660-2616
US

V. Phone/Fax

Practice location:
  • Phone: 888-562-5442
  • Fax:
Mailing address:
  • Phone: 714-584-7878
  • Fax: 940-220-3005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberARNP.AP.70061445-NP
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95017569
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95017569
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: