MEDICARE: NICOLE ANDREA 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	106E00000X	Assistant Behavior Analyst

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	XDJ93390961D	OTHER	CA	BLUE CROSS

General Provider Information

NPI Number	:	1356836985
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLE ANDREA AREVALO

Provider Business Mailing Address
First Line	:	2526 BUSH AVE
Second Line	:
City	:	RICHMOND
State	:	CA
Zip	:	94806-4530
Country	:	US
Telephone Number	:	510-776-2038
Fax Number	:

Provider Business Practice Location Address
First Line	:	2526 BUSH AVE
Second Line	:
City	:	RICHMOND
State	:	CA
Zip	:	94806-4530
Country	:	US
Telephone Number	:	510-776-2038
Fax Number	:

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

Provider Enumeration Date	:	06/26/2018
Last Update Date	:	06/26/2018

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Directions to “ NICOLE ANDREA AREVALO ” Practice Location

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