MEDICARE: ELIKA KORMEILI MFT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	IMF47953	CA
2	106H00000X	Marriage & Family Therapist	45623	CA

General Provider Information

NPI Number	:	1730205733
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIKA KORMEILI MFT

Provider Business Mailing Address
First Line	:	PO BOX 17144
Second Line	:	SUITE 320
City	:	ENCINO
State	:	CA
Zip	:	91416-7144
Country	:	US
Telephone Number	:	424-274-2256
Fax Number	:

Provider Business Practice Location Address
First Line	:	11755 WILSHIRE BLVD
Second Line	:	SUITE 1250
City	:	LOS ANGELES
State	:	CA
Zip	:	90025-1506
Country	:	US
Telephone Number	:	424-274-2256
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/21/2007
Last Update Date	:	04/04/2017

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