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General NPI Number Information
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NPI Number | 1326969817
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Entity Type | Organization
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Legal Business Name | SAN DIEGO PACE, LLC
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Dates
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Enumeration Date | 07/22/2026
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Last Update Date | 07/22/2026
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Provider Practice Location Address
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Address Line | 3364 BEYER BLVD
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City | SAN YSIDRO
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State | CA
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Zip | 92173-1322
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Country | US
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Telephone | 619-662-4100
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Fax |
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Provider Business Mailing Address
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Address Line | 8080 DAGGET ST
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City | SAN DIEGO
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State | CA
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Zip | 92111-2333
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Country | US
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Telephone | 619-662-4100
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Fax |
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Authorized Official
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Title or Position | PRESIDENT AND CEO
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Name | KEVIN MATTSON
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Credential |
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Telephone | 619-662-4100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251T00000X
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Taxonomy Name | PACE Provider Organization
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License Number |
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License Number State |
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