Healthcare Provider Details

I. General information

NPI: 1295243673
Provider Name (Legal Business Name): IVAN COVARRUBIAS RIOS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2018
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 MISSION AVE STE 120
OCEANSIDE CA
92058-7110
US

IV. Provider business mailing address

1701 MISSION AVE STE 120
OCEANSIDE CA
92058-7110
US

V. Phone/Fax

Practice location:
  • Phone: 760-439-2785
  • Fax: 760-439-6902
Mailing address:
  • Phone: 760-439-2785
  • Fax: 760-439-6902

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberMPSS-ZW2RTY
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: