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Individual
THEODORE AREVALO
Active
Individual
THEODORE AREVALO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
208M00000X
Hospitalist Physician
Primary
J3965
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
036734402
CIDC
—
05
—
36734401
—
TX
Enumeration date
08/10/2006
Last updated
05/22/2008
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