Basic Information
| Provider Information | |||||||||
| NPI: | 1417619818 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PABAND | ||||||||
| FirstName: | MASSOODA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 779 CORTE SAN LUIS | ||||||||
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| City: | OCEANSIDE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 920577516 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7608054562 | ||||||||
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| Practice Location | |||||||||
| Address1: | 5555 GROSSMONT CENTER DR | ||||||||
| Address2: | |||||||||
| City: | LA MESA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 919423019 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6197406000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/12/2021 | ||||||||
| LastUpdateDate: | 10/12/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/12/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP0808X | 95018777 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
No ID Information.