MEDICARE: VICTOR COVARRUBIAS PMHNP-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WP0807X	Child & Adolescent Psychiatric/Mental Health Registered Nurse	95147346	CA
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	95024768	CA

General Provider Information

NPI Number	:	1447803986
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VICTOR COVARRUBIAS PMHNP-BC

Provider Business Mailing Address
First Line	:	21550 OXNARD ST
Second Line	:
City	:	WOODLAND HILLS
State	:	CA
Zip	:	91367-7100
Country	:	US
Telephone Number	:	818-850-3250
Fax Number	:

Provider Business Practice Location Address
First Line	:	21550 OXNARD ST FL 3
Second Line	:
City	:	WOODLAND HILLS
State	:	CA
Zip	:	91367-7105
Country	:	US
Telephone Number	:	818-913-0090
Fax Number	:	747-888-5865

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/23/2019
Last Update Date	:	10/10/2024

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