Active NPI
Ellie Karimi, PHD
- Addiction (Substance Use Disorder) Psychologist
- Tustin, CA
National Provider Identifier
1326136599
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Addiction (Substance Use Disorder) Psychologist
- License
- PSY11769
- Practice address
- 17772 Irvine Blvd
Ste 102-4
Tustin, CA 92780-3256 - Phone
- (909) 242-5409
- NPI assigned
- Oct 11, 2006
- Last updated
- Dec 14, 2016
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Psychologist | 103TA0400X | PSY11769 | CA | Primary |
Addresses
Primary practice location
17772 Irvine Blvd
Ste 102-4
Tustin, CA 92780-3256
Mailing address
17772 Irvine Blvd
Ste 102-4
Tustin, CA 92780-3256
Phone (909) 242-5409
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSY11769 | CA | MD | Addiction (Substance Use Disorder) Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1160524800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1481673600000",
"number": "1326136599",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "17772 IRVINE BLVD",
"address_2": "STE 102-4",
"city": "TUSTIN",
"state": "CA",
"postal_code": "927803256",
"telephone_number": "909-242-5409"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "17772 IRVINE BLVD",
"address_2": "STE 102-4",
"city": "TUSTIN",
"state": "CA",
"postal_code": "927803256",
"telephone_number": "909-242-5409"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KARIMI",
"first_name": "ELLIE",
"name_prefix": "Dr.",
"credential": "PHD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-10-11",
"last_updated": "2016-12-14",
"status": "A"
},
"taxonomies": [
{
"code": "103TA0400X",
"taxonomy_group": "",
"desc": "Psychologist, Addiction (Substance Use Disorder)",
"state": "CA",
"license": "PSY11769",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
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Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 14, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.