Provider Demographics
NPI:1699856229
Name:PACE, JAMES BERNARD (PHD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:BERNARD
Last Name:PACE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1255 E HIGHAND AVE
Mailing Address - Street 2:SUITE 216
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92404
Mailing Address - Country:US
Mailing Address - Phone:909-882-1281
Mailing Address - Fax:909-882-1282
Practice Address - Street 1:1255 E HIGHAND AVE
Practice Address - Street 2:SUITE 216
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92404
Practice Address - Country:US
Practice Address - Phone:909-882-1281
Practice Address - Fax:909-882-1282
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2008-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY3845103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00PL38450Medicaid
CAR24940Medicare UPIN
CA00PL38450Medicare PIN