Healthcare Provider Details

I. General information

NPI: 1437453735
Provider Name (Legal Business Name): ROBERT C. PACE MD A MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/29/2010
Last Update Date: 08/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

521 E ELDER ST #105
FALLBROOK CA
92028-3081
US

IV. Provider business mailing address

521 E ELDER ST #105
FALLBROOK CA
92028-3081
US

V. Phone/Fax

Practice location:
  • Phone: 760-728-5851
  • Fax: 760-728-0703
Mailing address:
  • Phone: 760-728-5851
  • Fax: 760-728-0703

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberG21246
License Number StateCA

VIII. Authorized Official

Name: DR. ROBERT CLAYTON PACE
Title or Position: PRESIDENT
Credential: M.D.
Phone: 760-728-5851