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NPI Code Detail

MEDICARE: DENISE LASELLE MACE

MEDICARE: DENISE LASELLE MACE
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
1175T00000XPeer SpecialistMPSS-HVZNXOCA

General Provider Information

NPI Number : 1710708987
Entity Type Code : Individual
Provider Name (Legal Business Name) : DENISE LASELLE MACE
Provider Business Mailing Address
First Line : 3204 E AVENUE H10
Second Line :
City : LANCASTER
State : CA
Zip : 93535-2402
Country : US
Telephone Number : 660-916-6090
Fax Number :
Provider Business Practice Location Address
First Line : 44505 90TH ST W
Second Line :
City : LANCASTER
State : CA
Zip : 93536-7705
Country : US
Telephone Number : 661-726-2630
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/21/2024
Last Update Date : 05/07/2025

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Directions to “ DENISE LASELLE MACE ” Practice Location

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