Healthcare Provider Details

I. General information

NPI: 1851657746
Provider Name (Legal Business Name): TEDA ARUNRUT M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2012
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1172 N MACLAY AVE
SAN FERNANDO CA
91340-1328
US

IV. Provider business mailing address

1172 N. MACLAY AVE.
SAN FERNANDO CA
91340
US

V. Phone/Fax

Practice location:
  • Phone: 818-898-1388
  • Fax:
Mailing address:
  • Phone: 818-898-1388
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA129850
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: