Provider Demographics
NPI:1811361249
Name:ARREVILLAGA, MIREYA ELIZABETH
Entity Type:Individual
Prefix:MS
First Name:MIREYA
Middle Name:ELIZABETH
Last Name:ARREVILLAGA
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:MIREYA
Other - Middle Name:ELIZABETH
Other - Last Name:ARREVILAGA-TOBAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:326 US HIGHWAY 22
Mailing Address - Street 2:SUITE 6B
Mailing Address - City:GREEN BROOK
Mailing Address - State:NJ
Mailing Address - Zip Code:08812-1756
Mailing Address - Country:US
Mailing Address - Phone:732-752-6606
Mailing Address - Fax:732-752-6643
Practice Address - Street 1:326 US HIGHWAY 22
Practice Address - Street 2:SUITE 6B
Practice Address - City:GREEN BROOK
Practice Address - State:NJ
Practice Address - Zip Code:08812-1756
Practice Address - Country:US
Practice Address - Phone:732-752-6606
Practice Address - Fax:732-752-6643
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-23
Last Update Date:2015-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ18KT00407800225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ18KT00407800OtherNJ BOARD OF MASSAGE AND BODYWORK THERAPY