Provider Demographics
NPI:1215005525
Name:HAILEMARIAM, ELENI (MD)
Entity Type:Individual
Prefix:DR
First Name:ELENI
Middle Name:
Last Name:HAILEMARIAM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4000 W METROPOLITAN DR # 120
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-3504
Mailing Address - Country:US
Mailing Address - Phone:714-972-8157
Mailing Address - Fax:
Practice Address - Street 1:4000 W METROPOLITAN DR STE 120
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-3504
Practice Address - Country:US
Practice Address - Phone:714-972-3700
Practice Address - Fax:714-972-3744
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2019-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA000000A544502084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA54450Medicare ID - Type Unspecified
CAG24430Medicare UPIN