Provider Demographics
NPI:1376590604
Name:ARRUDA, JOHNNY (MD)
Entity type:Individual
Prefix:DR
First Name:JOHNNY
Middle Name:
Last Name:ARRUDA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:255 TERRACINA BLVD STE 201
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92373-4881
Mailing Address - Country:US
Mailing Address - Phone:909-793-2500
Mailing Address - Fax:909-793-2502
Practice Address - Street 1:255 TERRACINA BLVD STE 201A
Practice Address - Street 2:
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92373-4870
Practice Address - Country:US
Practice Address - Phone:909-793-2500
Practice Address - Fax:909-793-2502
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-30
Last Update Date:2024-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG69717174400000X, 207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G697170Medicaid
CA00G697170Medicaid