Provider Demographics
NPI:1801045323
Name:MASONI, ADRIAN E
Entity Type:Individual
Prefix:
First Name:ADRIAN
Middle Name:E
Last Name:MASONI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 70758
Mailing Address - Street 2:
Mailing Address - City:SUNNYVALE
Mailing Address - State:CA
Mailing Address - Zip Code:94086-0758
Mailing Address - Country:US
Mailing Address - Phone:408-736-7600
Mailing Address - Fax:408-736-7604
Practice Address - Street 1:479 E EVELYN AVE
Practice Address - Street 2:
Practice Address - City:SUNNYVALE
Practice Address - State:CA
Practice Address - Zip Code:94086-6358
Practice Address - Country:US
Practice Address - Phone:408-736-7600
Practice Address - Fax:408-736-7604
Is Sole Proprietor?:No
Enumeration Date:2008-09-09
Last Update Date:2011-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA35493225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ29361ZOtherGROUP PTAN
COBW780XMedicare PIN