Healthcare Provider Details

I. General information

NPI: 1427294479
Provider Name (Legal Business Name): CAROLINA AREVALO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/22/2008
Last Update Date: 02/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 RANDOLPH RD SUITE 800
CHARLOTTE NC
28207-1122
US

IV. Provider business mailing address

PO BOX 60447
CHARLOTTE NC
28260-0447
US

V. Phone/Fax

Practice location:
  • Phone: 704-384-1246
  • Fax: 704-384-6072
Mailing address:
  • Phone: 704-384-1246
  • Fax: 704-384-6072

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number2011-01037
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: