Provider Demographics
NPI:1194764530
Name:DUSOVICH, ALEXANDER (MD)
Entity type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:
Last Name:DUSOVICH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8306 WILSHIRE BLVD
Mailing Address - Street 2:#501
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90211-2382
Mailing Address - Country:US
Mailing Address - Phone:310-613-2414
Mailing Address - Fax:805-494-8379
Practice Address - Street 1:2701 W ALAMEDA AVE
Practice Address - Street 2:#503
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91505-4402
Practice Address - Country:US
Practice Address - Phone:818-845-0088
Practice Address - Fax:818-845-0924
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-04
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA559012084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A559010Medicaid
CA00A559010Medicaid
CAG65215Medicare UPIN
CA00A559010Medicaid