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General NPI Number Information
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NPI Number | 1396022000
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Entity Type | Organization
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Legal Business Name | PACE CLINIC
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Dates
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Enumeration Date | 11/08/2011
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Last Update Date | 11/08/2011
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Provider Practice Location Address
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Address Line | 2400 MOORPARK AVE STE 216B
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City | SAN JOSE
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State | CA
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Zip | 95128-2631
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Country | US
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Telephone | 408-885-5935
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Fax |
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Provider Business Mailing Address
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Address Line | 2400 MOORPARK AVE STE 216B
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City | SAN JOSE
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State | CA
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Zip | 95128-2631
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | INTERN & TRAINEE PROGRAM COORDINATO
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Name | MRS. DONNA COHEN CRETCHER
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Credential |
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Telephone | 408-792-3910
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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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