Provider Demographics
NPI:1598142689
Name:MASON, ANA MERLE (LPT)
Entity Type:Individual
Prefix:
First Name:ANA
Middle Name:MERLE
Last Name:MASON
Suffix:
Gender:F
Credentials:LPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18365 DON JUAN ST
Mailing Address - Street 2:
Mailing Address - City:LAKE ELSINORE
Mailing Address - State:CA
Mailing Address - Zip Code:92532-2095
Mailing Address - Country:US
Mailing Address - Phone:951-591-1201
Mailing Address - Fax:
Practice Address - Street 1:18365 DON JUAN ST.
Practice Address - Street 2:
Practice Address - City:LAKE ELSINORE
Practice Address - State:CA
Practice Address - Zip Code:92532-2095
Practice Address - Country:US
Practice Address - Phone:951-591-1201
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-28
Last Update Date:2015-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT20470167G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes167G00000XNursing Service ProvidersLicensed Psychiatric Technician