Provider Demographics
NPI:1689428518
Name:JENNA ARRUDA, M.D., A PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:JENNA ARRUDA, M.D., A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENNA
Authorized Official - Middle Name:
Authorized Official - Last Name:ARRUDA
Authorized Official - Suffix:
Authorized Official - Credentials:MD MPH CLC
Authorized Official - Phone:401-787-7491
Mailing Address - Street 1:171 MAIN ST # 142
Mailing Address - Street 2:
Mailing Address - City:LOS ALTOS
Mailing Address - State:CA
Mailing Address - Zip Code:94022-2912
Mailing Address - Country:US
Mailing Address - Phone:401-787-7491
Mailing Address - Fax:
Practice Address - Street 1:164 MAIN ST, SUITE 212
Practice Address - Street 2:
Practice Address - City:LOS ALTOS
Practice Address - State:CA
Practice Address - Zip Code:94022
Practice Address - Country:US
Practice Address - Phone:650-383-7246
Practice Address - Fax:650-284-0336
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-16
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center