Provider Demographics
NPI:1730729054
Name:XIOMARA COVARRUBIAS
Entity type:Organization
Organization Name:XIOMARA COVARRUBIAS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:XIOMARA
Authorized Official - Middle Name:
Authorized Official - Last Name:COVARRUBIAS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:619-209-8924
Mailing Address - Street 1:ANTONIO CASO 2055 ZONA URBANA RIO TIJUANA
Mailing Address - Street 2:
Mailing Address - City:TIJUANA
Mailing Address - State:BAJA CALIFORNA
Mailing Address - Zip Code:22010
Mailing Address - Country:MX
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:AVE A Y CALLE PRIMERA
Practice Address - Street 2:224
Practice Address - City:MEXICALI
Practice Address - State:VICENTE GUERRERO
Practice Address - Zip Code:21970
Practice Address - Country:MX
Practice Address - Phone:619-209-8924
Practice Address - Fax:619-566-4898
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-15
Last Update Date:2020-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty