Provider Demographics
NPI:1679834907
Name:COVARRUBIAS, ANTONIO JAVIER (MD)
Entity Type:Individual
Prefix:DR
First Name:ANTONIO
Middle Name:JAVIER
Last Name:COVARRUBIAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:500 SUPERIOR AVE STE 305
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92663-3660
Mailing Address - Country:US
Mailing Address - Phone:949-764-8960
Mailing Address - Fax:949-764-8961
Practice Address - Street 1:500 SUPERIOR AVE STE 305
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-3660
Practice Address - Country:US
Practice Address - Phone:949-764-8960
Practice Address - Fax:949-764-8961
Is Sole Proprietor?:No
Enumeration Date:2012-06-04
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA1331422086S0129X
390200000X
TXS10702086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program