Provider Demographics
NPI:1952565426
Name:AREVALO, FABIO A (DC)
Entity Type:Individual
Prefix:DR
First Name:FABIO
Middle Name:A
Last Name:AREVALO
Suffix:
Gender:M
Credentials:DC
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 362454
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00936-2454
Mailing Address - Country:US
Mailing Address - Phone:787-285-4528
Mailing Address - Fax:787-285-4528
Practice Address - Street 1:A - 1 CALLE DUFRESNE
Practice Address - Street 2:URB. SAN ANTONIO
Practice Address - City:HUMACAO
Practice Address - State:PR
Practice Address - Zip Code:00791-3931
Practice Address - Country:US
Practice Address - Phone:787-285-4528
Practice Address - Fax:787-285-4528
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-15
Last Update Date:2020-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR446111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation