Healthcare Provider Details

I. General information

NPI: 1992147748
Provider Name (Legal Business Name): DAMARIZ AREVALO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2013
Last Update Date: 07/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 W 6TH ST SUITE 111
LOS ANGELES CA
90017-1800
US

IV. Provider business mailing address

10514 FELTON AVE
LENNOX CA
90304-1708
US

V. Phone/Fax

Practice location:
  • Phone: 213-607-4400
  • Fax:
Mailing address:
  • Phone: 310-920-4020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number2400
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: