MEDICARE: DOLORES AREVALO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker	68326	CA
2	1041C0700X	Clinical Social Worker	85252	CA

General Provider Information

NPI Number	:	1255700027
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DOLORES AREVALO

Provider Business Mailing Address
First Line	:	1371 EXPOSITION BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90018-4530
Country	:	US
Telephone Number	:	323-316-0327
Fax Number	:

Provider Business Practice Location Address
First Line	:	1371 EXPOSITION BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90018-4530
Country	:	US
Telephone Number	:	323-316-0327
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/22/2015
Last Update Date	:	11/09/2022

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Directions to “ DOLORES AREVALO ” Practice Location

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