Healthcare Provider Details

I. General information

NPI: 1821717661
Provider Name (Legal Business Name): SEAN KELLEY MASTERS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2022
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 MISSION AVE
OCEANSIDE CA
92054-2835
US

IV. Provider business mailing address

801 MISSION AVE
OCEANSIDE CA
92054-2835
US

V. Phone/Fax

Practice location:
  • Phone: 760-492-6385
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number163534
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: