Healthcare Provider Details

I. General information

NPI: 1649038985
Provider Name (Legal Business Name): CLINICA MEDICA PACOIMA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/11/2024
Last Update Date: 03/24/2025
Certification Date: 03/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13630 VAN NUYS BLVD STE 107
PACOIMA CA
91331-3668
US

IV. Provider business mailing address

13630 VAN NUYS BLVD STE 107
PACOIMA CA
91331-3668
US

V. Phone/Fax

Practice location:
  • Phone: 747-777-6099
  • Fax: 747-227-3076
Mailing address:
  • Phone: 747-777-6099
  • Fax: 747-227-3076

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. STEFAN RUEHM
Title or Position: PRESIDENT
Credential: MD
Phone: 747-777-6099