Provider Demographics
NPI:1013539121
Name:MASON, SALLY KEI
Entity Type:Individual
Prefix:
First Name:SALLY
Middle Name:KEI
Last Name:MASON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:413 CHATEAU LA SALLE DR
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95111-3034
Mailing Address - Country:US
Mailing Address - Phone:408-679-2779
Mailing Address - Fax:
Practice Address - Street 1:510 PLAZA DR STE 170
Practice Address - Street 2:
Practice Address - City:FOLSOM
Practice Address - State:CA
Practice Address - Zip Code:95630-4790
Practice Address - Country:US
Practice Address - Phone:916-351-9400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-12
Last Update Date:2020-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TP0016XBehavioral Health & Social Service ProvidersPsychologistPrescribing (Medical)