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General NPI Number Information
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NPI Number | 1215603907
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Entity Type | Individual
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Provider Name | CARLOS MARTINUS COVARRUBIAS PMHNP-BC
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Gender | Male
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Dates
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Enumeration Date | 08/21/2021
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Last Update Date | 10/28/2024
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Provider Practice Location Address
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Address Line | 769 CENTRE ST STE 329
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City | JAMAICA PLAIN
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State | MA
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Zip | 02130-2557
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Country | US
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Telephone | 617-286-2603
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Fax | 617-518-4304
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Provider Business Mailing Address
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Address Line | 44 COURTNEY RD
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City | WEST ROXBURY
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State | MA
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Zip | 02132-1044
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Country | US
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Telephone | 617-515-6702
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Fax | 617-518-4304
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | RN2303809
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License Number State | MA
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