Provider Demographics
NPI:1639835119
Name:KARIMI-TALEGHANI, MITRA
Entity Type:Individual
Prefix:
First Name:MITRA
Middle Name:
Last Name:KARIMI-TALEGHANI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3512 GLENHURST AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90039-2125
Mailing Address - Country:US
Mailing Address - Phone:310-422-9576
Mailing Address - Fax:
Practice Address - Street 1:305 S HUDSON AVE STE 200
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91101-2910
Practice Address - Country:US
Practice Address - Phone:323-523-5721
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-09
Last Update Date:2021-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical