Basic Information
Provider Information
NPI: 1861465023
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: PACE
FirstName: DENISE
MiddleName: KARIN
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 8808 BALBOA AVE
Address2:  
City: SAN DIEGO
State: CA
PostalCode: 921231592
CountryCode: US
TelephoneNumber: 6196450169
FaxNumber:  
Practice Location
Address1: 8808 BALBOA AVE
Address2:  
City: SAN DIEGO
State: CA
PostalCode: 921231592
CountryCode: US
TelephoneNumber: 6195328225
FaxNumber: 6196450193
Other Information
ProviderEnumerationDate: 02/08/2006
LastUpdateDate: 04/29/2014
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
208000000XG52491CAY Allopathic & Osteopathic PhysiciansPediatrics 

No ID Information.


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