Healthcare Provider Details

I. General information

NPI: 1376517664
Provider Name (Legal Business Name): ANN O MASSION M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/14/2006
Last Update Date: 10/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12835 POINTE DEL MAR WAY SUITE ONE
DEL MAR CA
92014-3846
US

IV. Provider business mailing address

12835 POINTE DEL MAR WAY SUITE ONE
DEL MAR CA
92014-3846
US

V. Phone/Fax

Practice location:
  • Phone: 858-259-0599
  • Fax:
Mailing address:
  • Phone: 858-259-0599
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA49598
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: