Healthcare Provider Details

I. General information

NPI: 1174267470
Provider Name (Legal Business Name): RICHARD BERRETT PACE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/22/2022
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

390 NORTH LOOP ROAD
FORT IRWIN CA
92310
US

IV. Provider business mailing address

WEED ARMY COMMUNITY HOSPITAL 390 NORTH LOOP ROAD
FORT IRWIN CA
92310
US

V. Phone/Fax

Practice location:
  • Phone: 760-383-5289
  • Fax:
Mailing address:
  • Phone: 760-383-5289
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD-24122
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: