Healthcare Provider Details

I. General information

NPI: 1649240052
Provider Name (Legal Business Name): MICHAEL DENIS MASTERSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: MICHAEL DENIS MASTERSON M.D.

II. Dates (important events)

Enumeration Date: 01/26/2006
Last Update Date: 02/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 LA VENTA SUITE 202
WESTLAKE VILLAGE CA
91361
US

IV. Provider business mailing address

1250 LA VENTA SUITE 202
WESTLAKE VILLAGE CA
91361
US

V. Phone/Fax

Practice location:
  • Phone: 805-496-5153
  • Fax: 805-496-5202
Mailing address:
  • Phone: 805-496-5153
  • Fax: 805-496-5202

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License NumberG27552
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207RH0000X
TaxonomyHematology (Internal Medicine) Physician
License NumberG27552
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: