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General NPI Number Information
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NPI Number | 1811905029
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Entity Type | Individual
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Provider Name | GUILLLERMO JOSE COVARRUBIAS P.T.A.
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Gender | Male
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Dates
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Enumeration Date | 08/03/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 3851 S SOTO ST
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City | VERNON
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State | CA
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Zip | 90058-1718
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Country | US
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Telephone | 323-585-7162
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Fax | 323-282-4002
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Provider Business Mailing Address
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Address Line | 15222 SHADYBEND DR
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City | HACIENDA HEIGHTS
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State | CA
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Zip | 91745-2167
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Country | US
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Telephone | 562-686-2551
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Fax |
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | AT6108
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License Number State | CA
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