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General NPI Number Information
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NPI Number | 1326136599
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Entity Type | Individual
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Provider Name | ELLIE KARIMI PHD
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Gender | Female
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Dates
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Enumeration Date | 10/11/2006
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Last Update Date | 12/14/2016
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Provider Practice Location Address
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Address Line | 17772 IRVINE BLVD STE 102-4
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City | TUSTIN
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State | CA
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Zip | 92780-3256
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Country | US
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Telephone | 909-242-5409
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Fax |
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Provider Business Mailing Address
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Address Line | 17772 IRVINE BLVD STE 102-4
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City | TUSTIN
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State | CA
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Zip | 92780-3256
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Country | US
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Telephone | 909-242-5409
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Psychologist
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License Number | PSY11769
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License Number State | CA
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