Healthcare Provider Details

I. General information

NPI: 1790906170
Provider Name (Legal Business Name): JACE MEDICAL, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10843 MAGNOLIA BLVD SUITE 1
NORTH HOLLYWOOD CA
91601-3922
US

IV. Provider business mailing address

10843 MAGNOLIA BLVD SUITE 1
NORTH HOLLYWOOD CA
91601-3922
US

V. Phone/Fax

Practice location:
  • Phone: 818-505-8610
  • Fax:
Mailing address:
  • Phone: 818-505-8610
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number3835
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberA38484
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number12998
License Number StateCA

VIII. Authorized Official

Name: DR. CRAIG JACE
Title or Position: CEO
Credential: DOM, LAC, PA-C
Phone: 818-505-8610