MEDICARE: DR. MARTHA CECILIA MASSON PHD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	PSY13675	CA

General Provider Information

NPI Number	:	1952417289
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARTHA CECILIA MASSON PHD

Provider Business Mailing Address
First Line	:	PO BOX 1008
Second Line	:
City	:	RANCHO CUCAMONGA
State	:	CA
Zip	:	91729-1008
Country	:	US
Telephone Number	:	909-652-0100
Fax Number	:	909-652-0104

Provider Business Practice Location Address
First Line	:	9330 BASE LINE ROAD
Second Line	:	SUITE 103
City	:	RANCHO CUCAMONGA
State	:	CA
Zip	:	91701-5827
Country	:	US
Telephone Number	:	909-652-0100
Fax Number	:	909-652-0104

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/21/2006
Last Update Date	:	09/01/2009

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