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NPI Code Detail

MEDICARE: SPENCER PACE

MEDICARE: SPENCER 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
1390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1548844806
Entity Type Code : Individual
Provider Name (Legal Business Name) : SPENCER PACE
Provider Business Mailing Address
First Line : 11234 ANDERSON ST OFC
Second Line :
City : LOMA LINDA
State : CA
Zip : 92354-2804
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 9961 SIERRA AVE
Second Line :
City : FONTANA
State : CA
Zip : 92335-6720
Country : US
Telephone Number : 833-574-2273
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/11/2021
Last Update Date : 12/31/2025

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Directions to “ SPENCER PACE ” Practice Location

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