Healthcare Provider Details

I. General information

NPI: 1548978133
Provider Name (Legal Business Name): ALEXANDRA SARA DHUS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/11/2022
Last Update Date: 11/11/2025
Certification Date: 11/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 W COVINA BLVD
SAN DIMAS CA
91773-3205
US

IV. Provider business mailing address

1111 W COVINA BLVD
SAN DIMAS CA
91773-3205
US

V. Phone/Fax

Practice location:
  • Phone: 626-515-4214
  • Fax:
Mailing address:
  • Phone: 626-515-4202
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number12570
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: