Provider Demographics
NPI:1457641102
Name:MASON, RACHEL I (MD)
Entity Type:Individual
Prefix:DR
First Name:RACHEL
Middle Name:I
Last Name:MASON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:9517 TREASURE BEACH CT
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117-3609
Mailing Address - Country:US
Mailing Address - Phone:702-630-6496
Mailing Address - Fax:
Practice Address - Street 1:5864 S DURANGO DR
Practice Address - Street 2:STE 105
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89113-2276
Practice Address - Country:US
Practice Address - Phone:702-359-5462
Practice Address - Fax:725-206-7825
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-14
Last Update Date:2020-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE300222086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10026516601Medicaid