Healthcare Provider Details

I. General information

NPI: 1598713968
Provider Name (Legal Business Name): WILLIAM M PACE MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2006
Last Update Date: 01/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2438 PONDEROSA DRIVE N BLDG C STE #201
CAMARILLO CA
93010
US

IV. Provider business mailing address

PO BOX 26570
FRESNO CA
93729
US

V. Phone/Fax

Practice location:
  • Phone: 805-637-1313
  • Fax: 805-965-6712
Mailing address:
  • Phone: 559-455-4000
  • Fax: 559-455-4007

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207U00000X
TaxonomyNuclear Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. WILLIAM MICHAEL PACE
Title or Position: OWNER
Credential: MD
Phone: 805-637-1313