Provider Demographics
NPI:1467044073
Name:MASON, HEATHER (RD, CDCES)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:MASON
Suffix:
Gender:F
Credentials:RD, CDCES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5233 HUNTLEY ST UNIT 18
Mailing Address - Street 2:
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93063-3768
Mailing Address - Country:US
Mailing Address - Phone:805-390-7293
Mailing Address - Fax:
Practice Address - Street 1:122 E WASHINGTON BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90015-3601
Practice Address - Country:US
Practice Address - Phone:213-483-3600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-04
Last Update Date:2021-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1037008133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered