Healthcare Provider Details

I. General information

NPI: 1750986196
Provider Name (Legal Business Name): JOHNNY ARRUDA MD, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/03/2020
Last Update Date: 12/03/2020
Certification Date: 12/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

255 TERRACINA BLVD SUITE 201
REDLANDS CA
92373
US

IV. Provider business mailing address

255 TERRACINA BLVD SUITE 201
REDLANDS CA
92373
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 TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JOHNNY ARRUDA
Title or Position: OWNER/CEO
Credential: MD
Phone: 909-793-2500