Healthcare Provider Details

I. General information

NPI: 1194503011
Provider Name (Legal Business Name): JULIANNA COVARRUBIAS APCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2023
Last Update Date: 12/20/2024
Certification Date: 12/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1041 N TUSTIN AVE
SANTA ANA CA
92705
US

IV. Provider business mailing address

2321 W HALL AVE
SANTA ANA CA
92704-5514
US

V. Phone/Fax

Practice location:
  • Phone: 714-221-6400
  • Fax: 714-221-6401
Mailing address:
  • Phone: 714-600-1005
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: