Healthcare Provider Details

I. General information

NPI: 1457524977
Provider Name (Legal Business Name): MS. SANDRA HUSKELHUS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/04/2008
Last Update Date: 12/09/2024
Certification Date: 12/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2781 W RAMSEY ST STE 3&4
BANNING CA
92220-3700
US

IV. Provider business mailing address

9462 VAN NUYS BLVD
PANORAMA CITY CA
91402-1310
US

V. Phone/Fax

Practice location:
  • Phone: 951-417-6612
  • Fax:
Mailing address:
  • Phone: 818-891-8555
  • Fax: 818-891-8649

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: