MEDICARE: ANA L AREVALO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	172V00000X	Community Health Worker

General Provider Information

NPI Number	:	1205642519
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANA L AREVALO

Provider Business Mailing Address
First Line	:	6161 SANTA MONICA BLVD STE 304
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90038-4411
Country	:	US
Telephone Number	:	323-919-1606
Fax Number	:

Provider Business Practice Location Address
First Line	:	6161 SANTA MONICA BLVD STE 304
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90038-4411
Country	:	US
Telephone Number	:	310-304-5859
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/10/2024
Last Update Date	:	12/10/2024

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Directions to “ ANA L AREVALO ” Practice Location

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