Provider Demographics
NPI:1376370759
Name:MASON, DEVIN TAYLOR (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:DEVIN
Middle Name:TAYLOR
Last Name:MASON
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:DEVIN
Other - Middle Name:TAYLOR
Other - Last Name:DOTSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3255 JEMEZ DR
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92117-3502
Mailing Address - Country:US
Mailing Address - Phone:760-496-8037
Mailing Address - Fax:
Practice Address - Street 1:215 S HICKORY ST STE 114
Practice Address - Street 2:
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92025-4360
Practice Address - Country:US
Practice Address - Phone:760-454-7844
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-18
Last Update Date:2024-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95028193363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health