Healthcare Provider Details

I. General information

NPI: 1093314999
Provider Name (Legal Business Name): JUAN ALEJANDRO AREVALO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/21/2020
Last Update Date: 07/11/2026
Certification Date: 07/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 AVE LUIS MUNOZ MARIN
CAGUAS PR
00725-6184
US

IV. Provider business mailing address

170 CALLE GUAYAMA APT E605
SAN JUAN PR
00917-4619
US

V. Phone/Fax

Practice location:
  • Phone: 787-620-9770
  • Fax:
Mailing address:
  • Phone: 210-837-9505
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number17882-I
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPACN54
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number2304PA
License Number StatePR
# 4
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberTPPA806
License Number StateFL
# 5
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberPEJ270956
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: