Healthcare Provider Details

I. General information

NPI: 1548458466
Provider Name (Legal Business Name): TONY MASRI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2007
Last Update Date: 11/30/2020
Certification Date: 11/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

825 POLLARD RD STE 100
LOS GATOS CA
95032-1435
US

IV. Provider business mailing address

825 POLLARD RD STE 100
LOS GATOS CA
95032-1435
US

V. Phone/Fax

Practice location:
  • Phone: 408-866-3927
  • Fax: 408-866-3843
Mailing address:
  • Phone: 408-866-3927
  • Fax: 408-866-3843

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084S0012X
TaxonomySleep Medicine (Psychiatry & Neurology) Physician
License NumberA116894
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: