MEDICARE: PATRICIA ANNA MATUNDAN LACE

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	363LP2300X	Primary Care Nurse Practitioner	95037609	CA

General Provider Information

NPI Number	:	1558229526
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PATRICIA ANNA MATUNDAN LACE

Provider Business Mailing Address
First Line	:	13941 OLIVE MESA CT
Second Line	:
City	:	POWAY
State	:	CA
Zip	:	92064-3952
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	13941 OLIVE MESA CT
Second Line	:
City	:	POWAY
State	:	CA
Zip	:	92064-3952
Country	:	US
Telephone Number	:	805-625-4862
Fax Number	:

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

Provider Enumeration Date	:	01/09/2026
Last Update Date	:	01/09/2026

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