Healthcare Provider Details

I. General information

NPI: 1467520452
Provider Name (Legal Business Name): ACES 2020, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2006
Last Update Date: 02/27/2023
Certification Date: 02/27/2023
Deactivation Date: 02/07/2023
Reactivation Date: 02/23/2023

III. Provider practice location address

5333 MISSION CENTER RD STE 110
SAN DIEGO CA
92108-1347
US

IV. Provider business mailing address

PO BOX 33568
SAN DIEGO CA
92163
US

V. Phone/Fax

Practice location:
  • Phone: 855-223-7123
  • Fax: 619-278-0885
Mailing address:
  • Phone: 855-223-7123
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number15276
License Number StateCA

VIII. Authorized Official

Name: MR. LUKE JANA
Title or Position: CHIEF ADMINISTRATIVE OFFICER & GENE
Credential:
Phone: 619-889-4801