Provider Demographics
NPI:1962572586
Name:COVARRUBIAS, GONZALO ANTONIO (MD)
Entity type:Individual
Prefix:DR
First Name:GONZALO
Middle Name:ANTONIO
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 1:26801 PASEO ATREVIDA
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN CAPISTRANO
Mailing Address - State:CA
Mailing Address - Zip Code:92675-1508
Mailing Address - Country:US
Mailing Address - Phone:949-289-8150
Mailing Address - Fax:
Practice Address - Street 1:26801 PASEO ATREVIDA
Practice Address - Street 2:
Practice Address - City:SAN JUAN CAPISTRANO
Practice Address - State:CA
Practice Address - Zip Code:92675-1508
Practice Address - Country:US
Practice Address - Phone:949-289-8150
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA32492207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery