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General NPI Number Information
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NPI Number | 1609725092
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Entity Type | Individual
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Provider Name | SANDRA OLIVIA KHUMALO
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Gender | Female
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Dates
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Enumeration Date | 01/27/2026
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Last Update Date | 01/30/2026
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Provider Practice Location Address
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Address Line | 1102 S. ORACLE SUITE 18B - BUILDING 4
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City | MESA
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State | AZ
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Zip | 85204
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Country | US
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Telephone | 623-326-5719
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Fax | 620-647-4819
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Provider Business Mailing Address
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Address Line | 1818 E SOUTHERN AVE STE 18B
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City | MESA
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State | AZ
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Zip | 85204-5255
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Country | US
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Telephone | 623-326-5719
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Fax | 620-647-4819
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | OTC23011
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License Number State | AZ
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