| Clinica Medica Pacoima | |
|
13630 Van Nuys Blvd Ste 107 Pacoima CA 91331-3668 | |
| (747) 777-6099 | |
| (747) 474-4001 |
| Full Name | Clinica Medica Pacoima |
|---|---|
| Speciality | Internal Medicine |
| Location | 13630 Van Nuys Blvd Ste 107, Pacoima, California |
| Authorized Official Name and Position | Stefan Ruehm (PRESIDENT) |
| Authorized Official Contact | 7477776099 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Clinica Medica Pacoima 13630 Van Nuys Blvd Ste 107 Pacoima CA 91331-3668 Ph: (747) 777-6099 | Clinica Medica Pacoima 13630 Van Nuys Blvd Ste 107 Pacoima CA 91331-3668 Ph: (747) 777-6099 |
| NPI Number | 1649038985 |
|---|---|
| Provider Enumeration Date | 03/11/2024 |
| Last Update Date | 08/30/2024 |
| Medicare PECOS PAC ID | 1254770514 |
|---|---|
| Medicare Enrollment ID | O20240418003793 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1649038985 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| 261QR0200X | Clinic/center - Radiology | (* (Not Available)) | Secondary |
| Provider Name | Stefan G Ruehm |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1669416632 PECOS PAC ID: 6901850411 Enrollment ID: I20050308000846 |
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