MEDICARE: DR. ANTONIO JAVIER COVARRUBIAS M.D.

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	2086S0129X	Vascular Surgery Physician	A133142	CA

General Provider Information

NPI Number	:	1679834907
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANTONIO JAVIER COVARRUBIAS M.D.

Provider Business Mailing Address
First Line	:	500 SUPERIOR AVE STE 305
Second Line	:
City	:	NEWPORT BEACH
State	:	CA
Zip	:	92663-3660
Country	:	US
Telephone Number	:	949-764-8960
Fax Number	:	949-764-8961

Provider Business Practice Location Address
First Line	:	500 SUPERIOR AVE STE 305
Second Line	:
City	:	NEWPORT BEACH
State	:	CA
Zip	:	92663-3660
Country	:	US
Telephone Number	:	949-764-8960
Fax Number	:	949-764-8961

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

Provider Enumeration Date	:	06/04/2012
Last Update Date	:	11/02/2023

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