Healthcare Provider Details

I. General information

NPI: 1235269374
Provider Name (Legal Business Name): JEFFREY G. MACE, M.D., PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2007
Last Update Date: 01/31/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

242 GREEN VALLEY RD
FREEDOM CA
95019-3137
US

IV. Provider business mailing address

598 BROWNS VALLEY RD
WATSONVILLE CA
95076-0334
US

V. Phone/Fax

Practice location:
  • Phone: 831-724-1811
  • Fax: 831-724-1866
Mailing address:
  • Phone: 831-724-1811
  • Fax: 831-724-1866

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberG32527
License Number StateCA

VIII. Authorized Official

Name: DR. JEFFREY GENE MACE
Title or Position: PRESIDENT
Credential: M.D.
Phone: 831-724-1811