Healthcare Provider Details

I. General information

NPI: 1730898297
Provider Name (Legal Business Name): MASSSVCS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/22/2022
Last Update Date: 02/27/2025
Certification Date: 02/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

930 S MOUNT VERNON AVE STE 90
COLTON CA
92324-3928
US

IV. Provider business mailing address

930 S MOUNT VERNON AVE STE 90
COLTON CA
92324-3928
US

V. Phone/Fax

Practice location:
  • Phone: 909-660-0097
  • Fax:
Mailing address:
  • Phone: 909-660-0097
  • Fax: 840-788-5546

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JASEMINE MONET LAKEY
Title or Position: CHIEF EXECUTIVE OFFICER
Credential: M.S.
Phone: 909-921-1404