MEDICARE: PACE, A PSYCHOLOGY CORPORATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist

General Provider Information

NPI Number	:	1275986697
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PACE, A PSYCHOLOGY CORPORATION

Provider Business Mailing Address
First Line	:	10721 DROXFORD ST
Second Line	:	UNIT 2
City	:	CERRITOS
State	:	CA
Zip	:	90703-8090
Country	:	US
Telephone Number	:	818-298-3480
Fax Number	:	310-388-0245

Provider Business Practice Location Address
First Line	:	4433 E VILLAGE RD
Second Line	:	SUITE D
City	:	LONG BEACH
State	:	CA
Zip	:	90808-1505
Country	:	US
Telephone Number	:	818-298-3480
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	STANLEY CHOW
Credential	:	PSY.D.
Telephone Number	:	818-298-3480

Provider Enumeration Date	:	07/20/2016
Last Update Date	:	07/21/2016

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