Healthcare Provider Details

I. General information

NPI: 1447803986
Provider Name (Legal Business Name): VICTOR COVARRUBIAS PMHNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/23/2019
Last Update Date: 10/10/2024
Certification Date: 10/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21550 OXNARD ST FL 3
WOODLAND HILLS CA
91367-7105
US

IV. Provider business mailing address

21550 OXNARD ST
WOODLAND HILLS CA
91367-7100
US

V. Phone/Fax

Practice location:
  • Phone: 818-913-0090
  • Fax: 747-888-5865
Mailing address:
  • Phone: 818-850-3250
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Registered Nurse
License Number95147346
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95024768
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: