Provider Demographics
NPI:1134485907
Name:AREVALO, SONIA (DMD)
Entity Type:Individual
Prefix:DR
First Name:SONIA
Middle Name:
Last Name:AREVALO
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2561 3RD ST STE B
Mailing Address - Street 2:
Mailing Address - City:CERES
Mailing Address - State:CA
Mailing Address - Zip Code:95307-3230
Mailing Address - Country:US
Mailing Address - Phone:209-538-9299
Mailing Address - Fax:
Practice Address - Street 1:2561 3RD ST STE B
Practice Address - Street 2:
Practice Address - City:CERES
Practice Address - State:CA
Practice Address - Zip Code:95307-3230
Practice Address - Country:US
Practice Address - Phone:209-538-9299
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-06
Last Update Date:2021-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CA646781223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program