Individual
DR. EDWARD GUISANDE AREVALO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3262 HOLIDAY CT, SUITE 200, LA JOLLA, CA 92037-0026
(858) 922-3057
Mailing address
PO BOX 270472, SUITE 113, PMB 234, SAN DIEGO, CA 92198-2472
(858) 922-3057
(858) 300-0461
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
A49719
CA
2084P0804X
Child & Adolescent Psychiatry Physician
A49719
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
FF873A
MEDICARE GROUP PTAN
—
01
—
FH539Z
MEDICARE INDIVIDUAL PTAN
—
Enumeration date
01/15/2007
Last updated
06/30/2016
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