Provider Demographics
NPI:1811905029
Name:COVARRUBIAS, GUILLLERMO JOSE (PTA)
Entity type:Individual
Prefix:MR
First Name:GUILLLERMO
Middle Name:JOSE
Last Name:COVARRUBIAS
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15222 SHADYBEND DR
Mailing Address - Street 2:
Mailing Address - City:HACIENDA HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:91745-2167
Mailing Address - Country:US
Mailing Address - Phone:562-686-2551
Mailing Address - Fax:
Practice Address - Street 1:3851 S SOTO ST
Practice Address - Street 2:
Practice Address - City:VERNON
Practice Address - State:CA
Practice Address - Zip Code:90058-1718
Practice Address - Country:US
Practice Address - Phone:323-585-7162
Practice Address - Fax:323-282-4002
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAT6108225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant