MEDICARE: LATOSHA 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	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1710286497
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LATOSHA PACE

Provider Business Mailing Address
First Line	:	2701 N RAINBOW BLVD
Second Line	:	2179
City	:	LAS VEGAS
State	:	NV
Zip	:	89108-4558
Country	:	US
Telephone Number	:	313-399-9576
Fax Number	:

Provider Business Practice Location Address
First Line	:	2701 N RAINBOW BLVD
Second Line	:	2179
City	:	LAS VEGAS
State	:	NV
Zip	:	89108-4558
Country	:	US
Telephone Number	:	313-399-9576
Fax Number	:

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

Provider Enumeration Date	:	03/21/2011
Last Update Date	:	03/21/2011

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