Provider Demographics
NPI:1457139032
Name:COBARRUVIAS, BIANCA ANGELICA
Entity Type:Individual
Prefix:
First Name:BIANCA
Middle Name:ANGELICA
Last Name:COBARRUVIAS
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 1:360 MOBIL AVE
Mailing Address - Street 2:
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93010-6325
Mailing Address - Country:US
Mailing Address - Phone:805-504-6967
Mailing Address - Fax:
Practice Address - Street 1:1000 TOWN CENTER DR STE 500
Practice Address - Street 2:
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93036-1100
Practice Address - Country:US
Practice Address - Phone:805-983-6014
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-15
Last Update Date:2023-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11420101YP2500X
CA133046106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional