Provider Demographics
NPI:1245964402
Name:COVARRUBIAS, SIDNEY ALICIA (PA-C)
Entity type:Individual
Prefix:
First Name:SIDNEY
Middle Name:ALICIA
Last Name:COVARRUBIAS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4530 N 32ND ST STE 104
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85018-3357
Mailing Address - Country:US
Mailing Address - Phone:602-279-6282
Mailing Address - Fax:602-274-2157
Practice Address - Street 1:16611 S 40TH ST STE 120
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85048-0563
Practice Address - Country:US
Practice Address - Phone:480-706-4100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-13
Last Update Date:2025-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ10020363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant