Provider Demographics
NPI:1285880492
Name:ABTAHI-GONZALEZ, ELIKA
Entity type:Individual
Prefix:DR
First Name:ELIKA
Middle Name:
Last Name:ABTAHI-GONZALEZ
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 1:17772 IRVINE BLVD
Mailing Address - Street 2:STE 102-4
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-3256
Mailing Address - Country:US
Mailing Address - Phone:949-422-4749
Mailing Address - Fax:
Practice Address - Street 1:17772 IRVINE BLVD
Practice Address - Street 2:STE 102-4
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-3256
Practice Address - Country:US
Practice Address - Phone:949-422-4749
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-07
Last Update Date:2016-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health