Provider Demographics
NPI:1225734981
Name:ANCOVA INC.
Entity Type:Organization
Organization Name:ANCOVA INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTONIO
Authorized Official - Middle Name:JAVIER
Authorized Official - Last Name:COVARRUBIAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-356-8811
Mailing Address - Street 1:107 ANTHOLOGY
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-0891
Mailing Address - Country:US
Mailing Address - Phone:949-356-8811
Mailing Address - Fax:
Practice Address - Street 1:18111 BROOKHURST ST STE 5600
Practice Address - Street 2:
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-6728
Practice Address - Country:US
Practice Address - Phone:714-273-5896
Practice Address - Fax:714-432-8891
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-03
Last Update Date:2023-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Multi-Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-SpecialtyGroup - Multi-Specialty