Individual
AGATHA J COVARRUBIAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
3105 MCHENRY AVE STE 101, MODESTO, CA 95350-1439
(209) 575-2700
Mailing address
215 M ST, PATTERSON, CA 95363-2121
(205) 586-1983
(209) 874-3896
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
95069913
CA
207R00000X
Internal Medicine Physician
A70897
CA
207R00000X
Internal Medicine Physician
A76562
CA
363L00000X
Nurse Practitioner
Primary
95002944
CA
364SA2200X
Adult Health Clinical Nurse Specialist
60579117
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1093183261
—
CA
Enumeration date
10/27/2015
Last updated
12/16/2021
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