Provider Demographics
NPI:1265801856
Name:RODRIGUEZ, ALEJANDRO AREVALO
Entity type:Individual
Prefix:
First Name:ALEJANDRO
Middle Name:AREVALO
Last Name:RODRIGUEZ
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:PO BOX 5006
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94537-5006
Mailing Address - Country:US
Mailing Address - Phone:510-248-4000
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 5006
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94537-5006
Practice Address - Country:US
Practice Address - Phone:510-248-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-24
Last Update Date:2024-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No171M00000XOther Service ProvidersCase Manager/Care Coordinator