Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | DC 18530 | CA |
NPI | 1477615235 |
---|---|
Provider Name | Dr. Robert Christopher Mason |
First Address | La Mesa, CA 91942-0679 |
Second Address | La Mesa, CA 91942-0679 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/12/2006 |
Last Update Date | 24/05/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T18702 | (02) | CA |