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General NPI Number Information
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NPI Number | 1790373090
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Entity Type | Individual
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Provider Name | RICHARD EDUARDO AREVALO SR.
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Gender | Male
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Dates
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Enumeration Date | 01/04/2021
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Last Update Date | 12/13/2024
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Provider Practice Location Address
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Address Line | 151 NW 11TH ST STE W303
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City | HOMESTEAD
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State | FL
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Zip | 33030-4306
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Country | US
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Telephone | 786-743-4803
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Fax | 786-349-4314
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Provider Business Mailing Address
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Address Line | 14810 SW 296TH ST
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City | HOMESTEAD
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State | FL
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Zip | 33033-2824
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Country | US
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Telephone | 786-564-2702
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 11010693
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License Number State | FL
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