Provider Demographics
NPI:1861429631
Name:ARENAS, JESUS (MD)
Entity type:Individual
Prefix:DR
First Name:JESUS
Middle Name:
Last Name:ARENAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:JESSE
Other - Middle Name:PENUNURI
Other - Last Name:ARENAS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1840 N HACIENDA BLVD
Mailing Address - Street 2:SUITE 6
Mailing Address - City:LA PUENTE
Mailing Address - State:CA
Mailing Address - Zip Code:91744-1143
Mailing Address - Country:US
Mailing Address - Phone:626-917-4871
Mailing Address - Fax:626-917-8866
Practice Address - Street 1:1840 N HACIENDA BLVD
Practice Address - Street 2:SUITE 6
Practice Address - City:LA PUENTE
Practice Address - State:CA
Practice Address - Zip Code:91744-1143
Practice Address - Country:US
Practice Address - Phone:626-917-4871
Practice Address - Fax:626-917-8866
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-27
Last Update Date:2020-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG37465208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA47102Medicare UPIN