Provider Demographics
NPI:1144036575
Name:MOHAMMADIPOOR, ELHAM
Entity type:Individual
Prefix:
First Name:ELHAM
Middle Name:
Last Name:MOHAMMADIPOOR
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 1:27602 CARBALLO
Mailing Address - Street 2:
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92692-3230
Mailing Address - Country:US
Mailing Address - Phone:949-910-5180
Mailing Address - Fax:
Practice Address - Street 1:4281 KATELLA AVE
Practice Address - Street 2:
Practice Address - City:LOS ALAMITOS
Practice Address - State:CA
Practice Address - Zip Code:90720-3500
Practice Address - Country:US
Practice Address - Phone:626-270-9400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-10
Last Update Date:2024-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA150931103TF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily