Healthcare Provider Details

I. General information

NPI: 1114423001
Provider Name (Legal Business Name): RAVI MASSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/01/2018
Last Update Date: 08/12/2025
Certification Date: 08/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 N TUSTIN AVE
SANTA ANA CA
92705-3602
US

IV. Provider business mailing address

700 N TUSTIN AVE
SANTA ANA CA
92705-3602
US

V. Phone/Fax

Practice location:
  • Phone: 714-245-1444
  • Fax: 714-953-6604
Mailing address:
  • Phone: 714-245-1444
  • Fax: 714-953-6604

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberA200555
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License NumberA200555
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: