MEDICARE: GABRIEL 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	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1821300237
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GABRIEL COVARRUBIAS M.D.

Provider Business Mailing Address
First Line	:	26801 PASEO ATREVIDA
Second Line	:
City	:	SAN JUAN CAPISTRANO
State	:	CA
Zip	:	92675-1508
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	30280 RANCHO VIEJO RD
Second Line	:
City	:	SAN JUAN CAPISTRANO
State	:	CA
Zip	:	92675-1561
Country	:	US
Telephone Number	:	949-248-1632
Fax Number	:

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

Provider Enumeration Date	:	07/14/2010
Last Update Date	:	12/01/2021

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