Healthcare Provider Details

I. General information

NPI: 1255169900
Provider Name (Legal Business Name): KARLI SOU
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/24/2024
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3132 JEFFERSON ST
SAN DIEGO CA
92110-4421
US

IV. Provider business mailing address

3132 JEFFERSON ST
SAN DIEGO CA
92110-4421
US

V. Phone/Fax

Practice location:
  • Phone: 603-683-3100
  • Fax:
Mailing address:
  • Phone: 603-683-3100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number137908
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: