Provider Demographics
NPI:1992311815
Name:AZUL CENTER FOR INTEGRATION
Entity type:Organization
Organization Name:AZUL CENTER FOR INTEGRATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:CARMEN
Authorized Official - Last Name:COVARRUBIAS
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:559-313-5177
Mailing Address - Street 1:2010A HARBISON DR # 233
Mailing Address - Street 2:
Mailing Address - City:VACAVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95687-3900
Mailing Address - Country:US
Mailing Address - Phone:559-313-5177
Mailing Address - Fax:
Practice Address - Street 1:186 ISLE ROYAL CIRCLE
Practice Address - Street 2:
Practice Address - City:VACAVILLE
Practice Address - State:CA
Practice Address - Zip Code:95687
Practice Address - Country:US
Practice Address - Phone:707-430-1376
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-16
Last Update Date:2020-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
No251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
1528425584OtherNPI REGISTRY
1-15-19396OtherBCBA CERTIFICATION