Provider Demographics
NPI:1528425584
Name:COVARRUBIAS, MARIA DEL CARMEN
Entity type:Individual
Prefix:
First Name:MARIA DEL CARMEN
Middle Name:
Last Name:COVARRUBIAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5765 SW OLESON RD
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97225-1169
Mailing Address - Country:US
Mailing Address - Phone:559-313-5177
Mailing Address - Fax:707-561-0922
Practice Address - Street 1:121 SW SALMON ST FL 11
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97204-2908
Practice Address - Country:US
Practice Address - Phone:707-561-0134
Practice Address - Fax:707-561-0922
Is Sole Proprietor?:No
Enumeration Date:2016-01-21
Last Update Date:2020-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-15-19396103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst