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NPI Code Detail

MEDICARE: MR. GUILLLERMO JOSE COVARRUBIAS P.T.A.

MEDICARE: MR. GUILLLERMO JOSE COVARRUBIAS P.T.A.
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
1225200000XPhysical Therapy AssistantAT6108CA

General Provider Information

NPI Number : 1811905029
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. GUILLLERMO JOSE COVARRUBIAS P.T.A.
Provider Business Mailing Address
First Line : 15222 SHADYBEND DR
Second Line :
City : HACIENDA HEIGHTS
State : CA
Zip : 91745-2167
Country : US
Telephone Number : 562-686-2551
Fax Number :
Provider Business Practice Location Address
First Line : 3851 S SOTO ST
Second Line :
City : VERNON
State : CA
Zip : 90058-1718
Country : US
Telephone Number : 323-585-7162
Fax Number : 323-282-4002
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/03/2006
Last Update Date : 07/08/2007

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