Provider Demographics
NPI:1437942299
Name:COVARRUBIAS, DIEGO EDUARDO (LMT)
Entity type:Individual
Prefix:
First Name:DIEGO
Middle Name:EDUARDO
Last Name:COVARRUBIAS
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 SANDERS DR
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35811-9582
Mailing Address - Country:US
Mailing Address - Phone:256-620-1554
Mailing Address - Fax:
Practice Address - Street 1:3313 BOB WALLACE AVE SW STE 204A
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35805-6911
Practice Address - Country:US
Practice Address - Phone:256-620-1554
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-26
Last Update Date:2025-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL4059225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist