Provider Demographics
NPI:1376783845
Name:JOSE ENRIQUE AREVALO DDS, INC
Entity Type:Organization
Organization Name:JOSE ENRIQUE AREVALO DDS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/ DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:ENRIQUE
Authorized Official - Last Name:AREVALO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:909-465-6861
Mailing Address - Street 1:13161 PEYTON DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:CHINO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91709-6006
Mailing Address - Country:US
Mailing Address - Phone:909-465-6861
Mailing Address - Fax:909-465-6867
Practice Address - Street 1:13161 PEYTON DR
Practice Address - Street 2:SUITE B
Practice Address - City:CHINO HILLS
Practice Address - State:CA
Practice Address - Zip Code:91709-6006
Practice Address - Country:US
Practice Address - Phone:909-465-6861
Practice Address - Fax:909-465-6867
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-24
Last Update Date:2009-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA49453261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental