Provider Demographics
NPI:1326136599
Name:KARIMI, ELLIE (PHD)
Entity Type:Individual
Prefix:DR
First Name:ELLIE
Middle Name:
Last Name:KARIMI
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17772 IRVINE BLVD
Mailing Address - Street 2:STE 102-4
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-3256
Mailing Address - Country:US
Mailing Address - Phone:909-242-5409
Mailing Address - Fax:
Practice Address - Street 1:17772 IRVINE BLVD
Practice Address - Street 2:STE 102-4
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-3256
Practice Address - Country:US
Practice Address - Phone:909-242-5409
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2016-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY11769103TA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)