Provider Demographics
NPI:1962074849
Name:COVARRUBIAS, NOAH ALEXANDER
Entity type:Individual
Prefix:
First Name:NOAH
Middle Name:ALEXANDER
Last Name:COVARRUBIAS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1546 VERDE VISTA DR
Mailing Address - Street 2:
Mailing Address - City:MONTEREY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91754-2366
Mailing Address - Country:US
Mailing Address - Phone:626-497-4122
Mailing Address - Fax:
Practice Address - Street 1:13920 CITY CENTER DR
Practice Address - Street 2:
Practice Address - City:CHINO HILLS
Practice Address - State:CA
Practice Address - Zip Code:91709-5432
Practice Address - Country:US
Practice Address - Phone:866-351-8887
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-12
Last Update Date:2021-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician