Healthcare Provider Details

I. General information

NPI: 1336186691
Provider Name (Legal Business Name): AREVALO FAMILY MEDICAL GROUP INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2006
Last Update Date: 03/16/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1217 W WHITTIER BLVD
MONTEBELLO CA
90640-4300
US

IV. Provider business mailing address

1217 W WHITTIER BLVD
MONTEBELLO CA
90640-4642
US

V. Phone/Fax

Practice location:
  • Phone: 323-728-6070
  • Fax:
Mailing address:
  • Phone: 323-728-6070
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. RODOLFO ANTONIO AREVALO
Title or Position: CHIEF EXECUTIVE OFFICER
Credential: M.D.
Phone: 323-446-0201