MEDICARE: DR. SANDRA BASILY MIKHAIL PSY.D

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	PSY32620	CA
2	225C00000X	Rehabilitation Counselor
3	390200000X	Student in an Organized Health Care Education/Training Program
4	103TC2200X	Clinical Child & Adolescent Psychologist	PSY32620	CA

General Provider Information

NPI Number	:	1942560628
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SANDRA BASILY MIKHAIL PSY.D

Provider Business Mailing Address
First Line	:	1120 W LA VETA AVE STE 470
Second Line	:
City	:	ORANGE
State	:	CA
Zip	:	92868-4233
Country	:	US
Telephone Number	:	714-509-8481
Fax Number	:	714-509-8756

Provider Business Practice Location Address
First Line	:	1120 W LA VETA AVE STE 470
Second Line	:
City	:	ORANGE
State	:	CA
Zip	:	92868-4233
Country	:	US
Telephone Number	:	714-509-8481
Fax Number	:	714-509-8756

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/29/2012
Last Update Date	:	11/01/2021

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