Provider Demographics
NPI:1477944288
Name:COVARRUBIAS, DANIELLA
Entity Type:Individual
Prefix:
First Name:DANIELLA
Middle Name:
Last Name:COVARRUBIAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3507 JAIME ZAPATA MEMORIAL HWY
Mailing Address - Street 2:SUITE 7A
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78043-4769
Mailing Address - Country:US
Mailing Address - Phone:956-753-5600
Mailing Address - Fax:956-753-5602
Practice Address - Street 1:3507 JAIME ZAPATA MEMORIAL HWY
Practice Address - Street 2:SUITE 7A
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78043-4769
Practice Address - Country:US
Practice Address - Phone:956-753-5600
Practice Address - Fax:956-753-5602
Is Sole Proprietor?:No
Enumeration Date:2015-02-16
Last Update Date:2015-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX110065235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX110065OtherBOARD LICENSE #