Provider Demographics
NPI:1477606440
Name:MASSE, MONIQUE (MD)
Entity Type:Individual
Prefix:DR
First Name:MONIQUE
Middle Name:
Last Name:MASSE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12630 MONTE VISTA RD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:POWAY
Mailing Address - State:CA
Mailing Address - Zip Code:92064-2530
Mailing Address - Country:US
Mailing Address - Phone:858-485-9102
Mailing Address - Fax:858-485-0723
Practice Address - Street 1:12630 MONTE VISTA RD
Practice Address - Street 2:SUITE 202
Practice Address - City:POWAY
Practice Address - State:CA
Practice Address - Zip Code:92064-2530
Practice Address - Country:US
Practice Address - Phone:858-485-9102
Practice Address - Fax:858-485-0723
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-20
Last Update Date:2013-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG74290208000000X, 2084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA330965906OtherTAX ID (EIN)