Provider Demographics
NPI:1225404411
Name:COVARRUBIAS, NATHANIAL (PA)
Entity Type:Individual
Prefix:
First Name:NATHANIAL
Middle Name:
Last Name:COVARRUBIAS
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1307 CLEVELAND AVE
Mailing Address - Street 2:
Mailing Address - City:FRIONA
Mailing Address - State:TX
Mailing Address - Zip Code:79035-1121
Mailing Address - Country:US
Mailing Address - Phone:806-250-2781
Mailing Address - Fax:806-250-2088
Practice Address - Street 1:1307 CLEVELAND AVE
Practice Address - Street 2:
Practice Address - City:FRIONA
Practice Address - State:TX
Practice Address - Zip Code:79035-1121
Practice Address - Country:US
Practice Address - Phone:806-250-2781
Practice Address - Fax:806-250-2088
Is Sole Proprietor?:No
Enumeration Date:2015-08-11
Last Update Date:2015-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA09812363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant