Healthcare Provider Details

I. General information

NPI: 1679490916
Provider Name (Legal Business Name): ABRAHAM COVARRUBIAS LOZANO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2026
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

360 5TH ST
COLUSA CA
95932-2467
US

IV. Provider business mailing address

239 W E ST
RIO LINDA CA
95673-4025
US

V. Phone/Fax

Practice location:
  • Phone: 530-458-3614
  • Fax:
Mailing address:
  • Phone: 530-393-2003
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number112942
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: