Healthcare Provider Details

I. General information

NPI: 1558024059
Provider Name (Legal Business Name): ANJELICA T MASON LVN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/21/2021
Last Update Date: 10/21/2021
Certification Date: 10/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

660 E LOS ANGELES AVE STE B2
SIMI VALLEY CA
93065-1884
US

IV. Provider business mailing address

7246 REMMET AVE
CANOGA PARK CA
91303-1531
US

V. Phone/Fax

Practice location:
  • Phone: 805-522-1845
  • Fax:
Mailing address:
  • Phone: 818-206-0360
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number713013
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: