MEDICARE: DR. JOHN BENJAMIN JESS AREVALO MD, MBA

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	207PH0002X	Hospice and Palliative Medicine (Emergency Medicine) Physician	1015248	MA
2	207RH0002X	Hospice and Palliative Medicine (Internal Medicine) Physician	A174705	CA
3	208VP0014X	Interventional Pain Medicine Physician	1015248	MA
4	208VP0014X	Interventional Pain Medicine Physician	A174705	CA

General Provider Information

NPI Number	:	1629561170
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN BENJAMIN JESS AREVALO MD, MBA

Provider Business Mailing Address
First Line	:	520 ILLINOIS ST FL 4
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94143-2501
Country	:	US
Telephone Number	:	415-885-7246
Fax Number	:

Provider Business Practice Location Address
First Line	:	520 ILLINOIS ST FL 4
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94143-2501
Country	:	US
Telephone Number	:	415-885-7246
Fax Number	:

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

Provider Enumeration Date	:	06/10/2018
Last Update Date	:	03/17/2025

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