Provider Demographics
NPI:1861364879
Name:AREVALO, ANA BERTHA (CHW)
Entity type:Individual
Prefix:
First Name:ANA
Middle Name:BERTHA
Last Name:AREVALO
Suffix:
Gender:F
Credentials:CHW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 400895
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89140
Mailing Address - Country:US
Mailing Address - Phone:702-731-0909
Mailing Address - Fax:702-731-1020
Practice Address - Street 1:400 SHADOW LANE
Practice Address - Street 2:SUITE 104
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89106
Practice Address - Country:US
Practice Address - Phone:702-731-0909
Practice Address - Fax:702-826-4757
Is Sole Proprietor?:No
Enumeration Date:2025-09-19
Last Update Date:2025-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVCHW1-6202172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker