Healthcare Provider Details

I. General information

NPI: 1144947649
Provider Name (Legal Business Name): ALEJANDRO COVARRUBIAS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2022
Last Update Date: 05/05/2023
Certification Date: 05/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2280 DIAMOND BLVD
CONCORD CA
94520-5750
US

IV. Provider business mailing address

2 N MARKET ST
SAN JOSE CA
95113-1211
US

V. Phone/Fax

Practice location:
  • Phone: 925-483-2223
  • Fax:
Mailing address:
  • Phone: 559-974-8034
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: