Healthcare Provider Details

I. General information

NPI: 1750158952
Provider Name (Legal Business Name): ANDREA AREVALO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/07/2023
Last Update Date: 12/07/2023
Certification Date: 12/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8044 LIMONITE AVE
RIVERSIDE CA
92509-6107
US

IV. Provider business mailing address

10533 ROXBURY AVE
BLOOMINGTON CA
92316-2651
US

V. Phone/Fax

Practice location:
  • Phone: 951-685-0139
  • Fax:
Mailing address:
  • Phone: 909-520-4785
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number89066
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: