Provider Demographics
NPI:1215603907
Name:COVARRUBIAS, CARLOS MARTINUS (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:CARLOS
Middle Name:MARTINUS
Last Name:COVARRUBIAS
Suffix:
Gender:M
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 COURTNEY RD
Mailing Address - Street 2:
Mailing Address - City:WEST ROXBURY
Mailing Address - State:MA
Mailing Address - Zip Code:02132-1044
Mailing Address - Country:US
Mailing Address - Phone:617-515-6702
Mailing Address - Fax:617-518-4304
Practice Address - Street 1:769 CENTRE ST STE 329
Practice Address - Street 2:
Practice Address - City:JAMAICA PLAIN
Practice Address - State:MA
Practice Address - Zip Code:02130-2557
Practice Address - Country:US
Practice Address - Phone:617-286-2603
Practice Address - Fax:617-518-4304
Is Sole Proprietor?:No
Enumeration Date:2021-08-21
Last Update Date:2024-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2303809363LP0808X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty