Provider Demographics
NPI:1699484246
Name:AREVALO, ELVIRA JAZMIN
Entity type:Individual
Prefix:
First Name:ELVIRA
Middle Name:JAZMIN
Last Name:AREVALO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5328 LANIER ISLANDS PKWY
Mailing Address - Street 2:
Mailing Address - City:BUFORD
Mailing Address - State:GA
Mailing Address - Zip Code:30518-9071
Mailing Address - Country:US
Mailing Address - Phone:470-655-1970
Mailing Address - Fax:
Practice Address - Street 1:5328 LANIER ISLANDS PKWY
Practice Address - Street 2:
Practice Address - City:BUFORD
Practice Address - State:GA
Practice Address - Zip Code:30518-9071
Practice Address - Country:US
Practice Address - Phone:470-655-1970
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-22
Last Update Date:2022-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician