Healthcare Provider Details

I. General information

NPI: 1912372020
Provider Name (Legal Business Name): ALEXANDRA RUBALCABA LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ALEXANDRA SHAYE LMFT

II. Dates (important events)

Enumeration Date: 12/01/2015
Last Update Date: 04/27/2021
Certification Date: 04/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3460 OCEAN VIEW BLVD
GLENDALE CA
91208-1538
US

IV. Provider business mailing address

3460 OCEAN VIEW BLVD
GLENDALE CA
91208-1538
US

V. Phone/Fax

Practice location:
  • Phone: 310-994-9111
  • Fax:
Mailing address:
  • Phone: 310-994-9111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number65289
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: