MEDICARE: ELISA PACE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225400000X	Rehabilitation Practitioner

General Provider Information

NPI Number	:	1053722439
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELISA PACE

Provider Business Mailing Address
First Line	:	3075 ADELINE ST STE 120
Second Line	:
City	:	BERKELEY
State	:	CA
Zip	:	94703-2579
Country	:	US
Telephone Number	:	415-690-8856
Fax Number	:	510-848-4445

Provider Business Practice Location Address
First Line	:	3075 ADELINE ST STE 120
Second Line	:
City	:	BERKELEY
State	:	CA
Zip	:	94703-2579
Country	:	US
Telephone Number	:	510-848-1112
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/19/2014
Last Update Date	:	12/18/2025

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Directions to “ ELISA PACE ” Practice Location

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