Healthcare Provider Details

I. General information

NPI: 1215067558
Provider Name (Legal Business Name): COLLEEN MASTERS PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28 MONARCH BAY PLAZA SUITE N
DANA POINT CA
92629-1917
US

IV. Provider business mailing address

28 MONARCH BAY PLAZA SUITE N
DANA POINT CA
92629-1917
US

V. Phone/Fax

Practice location:
  • Phone: 949-489-8005
  • Fax:
Mailing address:
  • Phone: 949-489-8005
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY15609
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: