Provider Demographics
NPI:1598713968
Name:WILLIAM M PACE MD INC
Entity Type:Organization
Organization Name:WILLIAM M PACE MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:PACE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:805-637-1313
Mailing Address - Street 1:PO BOX 26570
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93729
Mailing Address - Country:US
Mailing Address - Phone:559-455-4000
Mailing Address - Fax:559-455-4007
Practice Address - Street 1:2438 PONDEROSA DRIVE N
Practice Address - Street 2:BLDG C STE #201
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93010
Practice Address - Country:US
Practice Address - Phone:805-637-1313
Practice Address - Fax:805-965-6712
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-05
Last Update Date:2011-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207U00000XAllopathic & Osteopathic PhysiciansNuclear MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW19880Medicare PIN
CADF1376Medicare PIN