Provider Demographics
NPI:1104491901
Name:VARGAS COVARRUBIAS, ALEXANDER (LMT)
Entity type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:
Last Name:VARGAS COVARRUBIAS
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7145 E 26TH ST
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85365-8649
Mailing Address - Country:US
Mailing Address - Phone:928-271-9196
Mailing Address - Fax:
Practice Address - Street 1:7145 E 26TH ST
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85365-8649
Practice Address - Country:US
Practice Address - Phone:928-271-9196
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-24
Last Update Date:2021-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZMT-22814225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist