Healthcare Provider Details

I. General information

NPI: 1700771433
Provider Name (Legal Business Name): PEDRO MARTIN AREVALO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/11/2025
Last Update Date: 06/11/2025
Certification Date: 06/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29215 JACOBS RIVER DR
KATY TX
77494-6959
US

IV. Provider business mailing address

29215 JACOBS RIVER DR
KATY TX
77494-6959
US

V. Phone/Fax

Practice location:
  • Phone: 239-350-8170
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171R00000X
TaxonomyInterpreter
License NumberLCI-2544
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: