Basic Information
Provider Information | |||||||||
NPI: | 1760736847 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | AREVALO | ||||||||
FirstName: | VERONICA | ||||||||
MiddleName: |   | ||||||||
NamePrefix: | MS. | ||||||||
NameSuffix: |   | ||||||||
Credential: | LSA, APRN, FNP-BC | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 6181 SARATOGA BLVD | ||||||||
Address2: | UNIT 117 | ||||||||
City: | CORPUS CHRISTI | ||||||||
State: | TX | ||||||||
PostalCode: | 784142475 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3614445148 | ||||||||
FaxNumber: | 3614445495 | ||||||||
Practice Location | |||||||||
Address1: | 1 SUGAR CREEK CENTER BLVD STE 618 | ||||||||
Address2: |   | ||||||||
City: | SUGAR LAND | ||||||||
State: | TX | ||||||||
PostalCode: | 774783540 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8326554141 | ||||||||
FaxNumber: | 7134575188 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 10/29/2012 | ||||||||
LastUpdateDate: | 09/02/2021 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 09/02/2021 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 1050107 | TX | Y |   | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 246ZC0007X | 134194 | TX | N |   | Technologists, Technicians & Other Technical Service Providers | Specialist/Technologist, Other | Certified First Assistant |
ID Information
ID | Type | State | Issuer | Description | 8LV716 | 01 | TX | BCBS - UNIVERSAL SURGICAL ASSISTANTS | OTHER | 8LW317 | 01 | TX | BCBS - UNIVERSAL SURGICAL PARTNERS INC | OTHER | 8LW190 | 01 | TX | BCBS - BLUE STAR SURGICAL ASSISTANTS LLC | OTHER | 8LY833 | 01 | TX | BCBS - XCITE SURGICAL | OTHER | SA00681 | 01 | TX | TEXAS MEDICAL BOARD | OTHER |