Provider Demographics
NPI:1689478174
Name:MASON, JARRETT WALTER
Entity type:Individual
Prefix:
First Name:JARRETT
Middle Name:WALTER
Last Name:MASON
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3500 W MANCHESTER BLVD UNIT 268
Mailing Address - Street 2:
Mailing Address - City:INGLEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90305-4268
Mailing Address - Country:US
Mailing Address - Phone:424-227-2064
Mailing Address - Fax:
Practice Address - Street 1:1200 41ST AVE STE H
Practice Address - Street 2:
Practice Address - City:CAPITOLA
Practice Address - State:CA
Practice Address - Zip Code:95010-3900
Practice Address - Country:US
Practice Address - Phone:831-346-6886
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-03
Last Update Date:2025-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA3068062251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic