Healthcare Provider Details

I. General information

NPI: 1134094170
Provider Name (Legal Business Name): CAROLINE MASON PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/08/2025
Last Update Date: 01/06/2026
Certification Date: 01/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

535 E MAIN ST
TUSTIN CA
92780-4453
US

IV. Provider business mailing address

535 E MAIN ST
TUSTIN CA
92780-4453
US

V. Phone/Fax

Practice location:
  • Phone: 949-466-6055
  • Fax: 949-281-7900
Mailing address:
  • Phone: 949-466-6055
  • Fax: 949-281-7900

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: