Provider Demographics
NPI:1093314999
Name:AREVALO, JUAN ALEJANDRO (MD)
Entity Type:Individual
Prefix:DR
First Name:JUAN
Middle Name:ALEJANDRO
Last Name:AREVALO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:242 LEMING DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78201-3742
Mailing Address - Country:US
Mailing Address - Phone:210-837-9505
Mailing Address - Fax:
Practice Address - Street 1:SIERRA GRANDE 1205
Practice Address - Street 2:
Practice Address - City:GUADALAJARA
Practice Address - State:JALISCO
Practice Address - Zip Code:44290
Practice Address - Country:MX
Practice Address - Phone:332-370-1727
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-21
Last Update Date:2020-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHSE29840207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine