Provider Demographics
NPI:1710211180
Name:PACE, LEA MARIE (PA)
Entity type:Individual
Prefix:
First Name:LEA
Middle Name:MARIE
Last Name:PACE
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:LEA
Other - Middle Name:MARIE
Other - Last Name:DUNN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4452 PARK BLVD STE 306
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92116-4049
Mailing Address - Country:US
Mailing Address - Phone:619-206-4232
Mailing Address - Fax:833-972-5097
Practice Address - Street 1:4452 PARK BLVD STE 306
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92116-4049
Practice Address - Country:US
Practice Address - Phone:619-206-4232
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-01
Last Update Date:2024-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN10001128A363A00000X
CAPA21171363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant