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General NPI Number Information
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NPI Number | 1184496739
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Entity Type | Organization
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Legal Business Name | HIGH DESERT PACE CENTER
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Dates
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Enumeration Date | 10/26/2023
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Last Update Date | 10/26/2023
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Provider Practice Location Address
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Address Line | 11833 AMETHYST ST.
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City | VICTORVILLE
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State | CA
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Zip | 92392
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Country | US
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Telephone | 760-932-0920
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Fax | 760-299-9464
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Provider Business Mailing Address
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Address Line | 472 W LEXINGTON AVE
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City | CLOVIS
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State | CA
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Zip | 93619-8362
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Country | US
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Telephone | 559-930-7722
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | NICOLE GARZA
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Credential |
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Telephone | 559-930-7722
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QG0300X
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Taxonomy Name | Geriatric Medicine (Family Medicine) Physician
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License Number |
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License Number State |
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