Provider Demographics
NPI:1124080197
Name:COVARRUBIAS, EDGAR ANGEL (MD)
Entity type:Individual
Prefix:DR
First Name:EDGAR
Middle Name:ANGEL
Last Name:COVARRUBIAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 31988
Mailing Address - Street 2:
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33420-1988
Mailing Address - Country:US
Mailing Address - Phone:561-622-3875
Mailing Address - Fax:561-622-4614
Practice Address - Street 1:3370 BURNS ROAD ,
Practice Address - Street 2:# 106
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410-4327
Practice Address - Country:US
Practice Address - Phone:561-622-3875
Practice Address - Fax:561-622-4614
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2012-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0036593174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD55922Medicare UPIN
FL50963Medicare ID - Type Unspecified