Provider Demographics
NPI:1932402559
Name:MASON, DIANE JOAN (RN)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:JOAN
Last Name:MASON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:136 S LARKWOOD ST
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92808-1213
Mailing Address - Country:US
Mailing Address - Phone:714-315-4478
Mailing Address - Fax:
Practice Address - Street 1:136 S LARKWOOD ST
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92808-1213
Practice Address - Country:US
Practice Address - Phone:714-315-4478
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-21
Last Update Date:2010-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA396268163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse