Provider Demographics
NPI:1619273349
Name:AREVALO, GLORIA I
Entity Type:Individual
Prefix:
First Name:GLORIA
Middle Name:I
Last Name:AREVALO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 640447
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:FL
Mailing Address - Zip Code:34464-0447
Mailing Address - Country:US
Mailing Address - Phone:352-527-8221
Mailing Address - Fax:352-527-8222
Practice Address - Street 1:2581 W APRICOT DR
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:FL
Practice Address - Zip Code:34465-3054
Practice Address - Country:US
Practice Address - Phone:352-527-8221
Practice Address - Fax:352-527-8222
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-27
Last Update Date:2011-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL690885397Medicaid
FL690885398Medicaid
FL690885396Medicaid