Healthcare Provider Details

I. General information

NPI: 1568095867
Provider Name (Legal Business Name): LIVIA MIGDALIA AREVALO FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/15/2020
Last Update Date: 11/01/2024
Certification Date: 11/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3306 W ROOSEVELT ST
PHOENIX AZ
85009-3404
US

IV. Provider business mailing address

3306 W ROOSEVELT ST
PHOENIX AZ
85009-3404
US

V. Phone/Fax

Practice location:
  • Phone: 602-826-2634
  • Fax: 602-889-9404
Mailing address:
  • Phone: 602-826-2634
  • Fax: 602-889-9404

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number235065
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number235065
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: