Provider Demographics
NPI:1568909927
Name:AREVALO, ERIC
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:
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 1:5755 COTTLE RD BLDG 23
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95123-3600
Mailing Address - Country:US
Mailing Address - Phone:909-973-7457
Mailing Address - Fax:
Practice Address - Street 1:5755 COTTLE RD BLDG 23
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95123-3600
Practice Address - Country:US
Practice Address - Phone:909-973-7457
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-24
Last Update Date:2019-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program