Provider Demographics
NPI:1992408645
Name:AREVALO, FABRICIO L
Entity type:Individual
Prefix:
First Name:FABRICIO
Middle Name:L
Last Name:AREVALO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:348 BRIGHTWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:TORRINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06790-3715
Mailing Address - Country:US
Mailing Address - Phone:860-921-4802
Mailing Address - Fax:
Practice Address - Street 1:348 BRIGHTWOOD AVE
Practice Address - Street 2:
Practice Address - City:TORRINGTON
Practice Address - State:CT
Practice Address - Zip Code:06790-3715
Practice Address - Country:US
Practice Address - Phone:860-921-4802
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-22
Last Update Date:2023-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer