Azadeh Ellsworth, PMHNP

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

95011907 Issued in CA

Practice address

1752 S Victoria Ave Ste 250
Ventura, CA 93003

Phone

(805) 650-3880

NPI assigned

May 31, 2019

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

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Jun 16, 2026 through Jun 16, 2028

Medicare enrollment (NPD)

Not enrolled

State licenses

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.

• Lee D. Mendiola MD PC

  • Psychiatry Physician
  • Ventura, CA
  • NPI 1447343710
  NPD (past)

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

{
    "created_epoch": "1559260800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1566864000000",
    "number": "1730747239",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1752 S VICTORIA AVE STE 250",
            "city": "VENTURA",
            "state": "CA",
            "postal_code": "930036152"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1752 S VICTORIA AVE STE 250",
            "city": "VENTURA",
            "state": "CA",
            "postal_code": "93003",
            "telephone_number": "805-650-3880"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "243 Riverdale Ct Apt 418",
            "address_purpose": "LOCATION",
            "city": "Camarillo",
            "state": "CA",
            "postal_code": "930127791",
            "country_code": "US",
            "telephone_number": "805-559-5058",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ELLSWORTH",
        "first_name": "AZADEH",
        "credential": "PMHNP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-05-31",
        "last_updated": "2019-08-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "CA",
            "license": "95011907",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Susan Eligado, RN
• Elixir Lifestyle Medicine
• Joseph David Elkins
• Graham James Ellis, DO
• Larry Edward Ellis, RADT
• Heidi Michelle Elowitch, PHD
• Elsaid Elrify, MD
• Jennifer Jacobs Elson, LCSW
• Shaundriques Vontae Elston, MHA
• Embrace Yourself Psychotherapy

• Psychiatric/Mental Health Nurse Practitioner in Ventura, CA
• Providers in Ventura, CA by specialty
• Psychiatric/Mental Health Nurse Practitioner in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 27, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.