Provider Demographics
NPI:1396841086
Name:AREVALO, DIANA (MD)
Entity Type:Individual
Prefix:DR
First Name:DIANA
Middle Name:
Last Name:AREVALO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:DIANA
Other - Middle Name:
Other - Last Name:AREVALO-VALENCIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:171 HUGUENOT ST
Mailing Address - Street 2:
Mailing Address - City:NEW ROCHELLE
Mailing Address - State:NY
Mailing Address - Zip Code:10801-7760
Mailing Address - Country:US
Mailing Address - Phone:914-607-5820
Mailing Address - Fax:914-607-5821
Practice Address - Street 1:171 HUGUENOT ST
Practice Address - Street 2:
Practice Address - City:NEW ROCHELLE
Practice Address - State:NY
Practice Address - Zip Code:10801-7760
Practice Address - Country:US
Practice Address - Phone:914-607-5820
Practice Address - Fax:914-607-5821
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2016-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY257679207R00000X
CT053452207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009939117Medicaid
ALI62365Medicare UPIN
ALP00390899OtherRAILROAD PROVIDER NUM
ALDB8444OtherRAILROAD GROUP NUM