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General NPI Number Information
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NPI Number | 1932829579
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Entity Type | Individual
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Provider Name | HAILEY AMANDA MASON PA
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Gender | Female
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Dates
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Enumeration Date | 09/02/2022
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Last Update Date | 10/03/2024
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Provider Practice Location Address
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Address Line | 6136 LAKE MURRAY BLVD
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City | LA MESA
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State | CA
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Zip | 91942-2502
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Country | US
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Telephone | 877-693-6266
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Fax |
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Provider Business Mailing Address
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Address Line | 4275 MISSION BAY DR APT 316
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City | SAN DIEGO
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State | CA
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Zip | 92109-5764
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Country | US
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Telephone | 626-483-0299
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA64486
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License Number State | CA
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