Provider Demographics
NPI:1598381683
Name:COVARRUBIAS, JESSICA VIRIDIANA (DDS)
Entity Type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:VIRIDIANA
Last Name:COVARRUBIAS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17341 ORANGE WAY
Mailing Address - Street 2:
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92335-3932
Mailing Address - Country:US
Mailing Address - Phone:909-227-9310
Mailing Address - Fax:
Practice Address - Street 1:2817 W LOOP 250 N STE B
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79705-3205
Practice Address - Country:US
Practice Address - Phone:432-694-4800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-24
Last Update Date:2020-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX36341122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist