Mitra H Elmi

Primary specialty

Marriage & Family TherapistTaxonomy code 106H00000X

License

58302 Issued in CA

Practice address

4701 Von Karman Ave Ste 328
Newport Beach, CA 92660-8136

Phone

(949) 424-3564

NPI assigned

Sep 17, 2012

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Advanced Psychological Associates & Wellness Center PC

  • Community/Behavioral Health Agency
  • Rancho Cucamonga, CA
  • NPI 1417262619
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1347840000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1705881600000",
    "number": "1639429640",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "149 STANFORD CT",
            "city": "IRVINE",
            "state": "CA",
            "postal_code": "926121673",
            "telephone_number": "949-424-3564"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4701 VON KARMAN AVE STE 328",
            "city": "NEWPORT BEACH",
            "state": "CA",
            "postal_code": "926608136",
            "telephone_number": "949-424-3564"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "324 E Bixby Rd",
            "address_purpose": "LOCATION",
            "city": "Long Beach",
            "state": "CA",
            "postal_code": "908073432",
            "country_code": "US",
            "telephone_number": "562-595-8111",
            "fax_number": "562-595-8148",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ELMI",
        "first_name": "MITRA",
        "middle_name": "H",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-09-17",
        "last_updated": "2024-01-22",
        "certification_date": "2024-01-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "CA",
            "license": "58302",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jordan Dulay Ellfeldt, OD
• Carrie Susanne Ellis, AGACNP
• Kristen Ellis, RDN
• Zackry Calvin Ellis, PA-C
• Christopher Lee Ellstrom, MD
• Roak Gordon Ely II
• Em Beaute
• Alireza Emdadi, M.D.
• Emere Medical Professional Corporation
• Emergency Physicians of Orange County

• Marriage & Family Therapist in Newport Beach, CA
• Providers in Newport Beach, CA by specialty
• Marriage & Family Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 22, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.