Healthcare Provider Details

I. General information

NPI: 1629561170
Provider Name (Legal Business Name): JOHN BENJAMIN JESS AREVALO MD, MBA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: BEN AREVALO MD, MBA

II. Dates (important events)

Enumeration Date: 06/10/2018
Last Update Date: 03/17/2025
Certification Date: 03/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 ILLINOIS ST FL 4
SAN FRANCISCO CA
94143-2501
US

IV. Provider business mailing address

520 ILLINOIS ST FL 4
SAN FRANCISCO CA
94143-2501
US

V. Phone/Fax

Practice location:
  • Phone: 415-885-7246
  • Fax:
Mailing address:
  • Phone: 415-885-7246
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207PH0002X
TaxonomyHospice and Palliative Medicine (Emergency Medicine) Physician
License Number1015248
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License NumberA174705
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number1015248
License Number StateMA
# 4
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License NumberA174705
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: