Provider Demographics
NPI:1114797131
Name:MASON, VICTORIA GRACE
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:GRACE
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 1:1137 ANDREW LN
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92881-8680
Mailing Address - Country:US
Mailing Address - Phone:951-751-8522
Mailing Address - Fax:
Practice Address - Street 1:7471 RUDELL RD
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92881-4278
Practice Address - Country:US
Practice Address - Phone:707-928-8113
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-02
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA133316106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist