Provider Demographics
NPI:1124364955
Name:AREVALO, PEDRO JOSE
Entity Type:Individual
Prefix:MR
First Name:PEDRO
Middle Name:JOSE
Last Name:AREVALO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19949 RANDOLPH PL
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80249-8628
Mailing Address - Country:US
Mailing Address - Phone:303-219-4259
Mailing Address - Fax:
Practice Address - Street 1:11059 E BETHANY DR
Practice Address - Street 2:SUITE 200
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80014-2622
Practice Address - Country:US
Practice Address - Phone:303-617-2300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-26
Last Update Date:2012-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker