Healthcare Provider Details

I. General information

NPI: 1942505490
Provider Name (Legal Business Name): ROBERT A. RUELAZ, MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/13/2011
Last Update Date: 09/30/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 S CHEVY CHASE DR SUITE 108
GLENDALE CA
91205-4431
US

IV. Provider business mailing address

801 S CHEVY CHASE DR SUITE 108
GLENDALE CA
91205-4431
US

V. Phone/Fax

Practice location:
  • Phone: 818-246-2456
  • Fax:
Mailing address:
  • Phone: 818-246-2456
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA78097
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberA78097
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License NumberA78097
License Number StateCA

VIII. Authorized Official

Name: MR. PAUL BERNARD
Title or Position: PRESIDENT
Credential:
Phone: 818-932-4656