Provider Demographics
NPI:1568903664
Name:AREVALO, LOLITA (SLP)
Entity Type:Individual
Prefix:
First Name:LOLITA
Middle Name:
Last Name:AREVALO
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2535 S MERIDIAN APT W104
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98373-2735
Mailing Address - Country:US
Mailing Address - Phone:253-904-7631
Mailing Address - Fax:
Practice Address - Street 1:2535 S MERIDIAN APT W104
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98373-2735
Practice Address - Country:US
Practice Address - Phone:253-904-7631
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-09
Last Update Date:2017-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist