Healthcare Provider Details

I. General information

NPI: 1497676985
Provider Name (Legal Business Name): SAN DIEGO PACE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2026
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

880 THIRD AVE STE A
CHULA VISTA CA
91911-1305
US

IV. Provider business mailing address

8080 DAGGET ST
SAN DIEGO CA
92111-2333
US

V. Phone/Fax

Practice location:
  • Phone: 619-662-4100
  • Fax:
Mailing address:
  • Phone: 619-662-4100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251T00000X
TaxonomyPACE Provider Organization
License Number
License Number State

VIII. Authorized Official

Name: KEVIN MATTSON
Title or Position: PRESIDENT AND CEO
Credential:
Phone: 619-662-4100