Healthcare Provider Details

I. General information

NPI: 1376590604
Provider Name (Legal Business Name): JOHNNY ARRUDA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/30/2006
Last Update Date: 10/07/2024
Certification Date: 10/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

255 TERRACINA BLVD STE 201A
REDLANDS CA
92373-4870
US

IV. Provider business mailing address

255 TERRACINA BLVD STE 201
REDLANDS CA
92373-4881
US

V. Phone/Fax

Practice location:
  • Phone: 909-793-2500
  • Fax: 909-793-2502
Mailing address:
  • Phone: 909-793-2500
  • Fax: 909-793-2502

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberG69717
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberG69717
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: