Basic Information
| Provider Information | |||||||||
| NPI: | 1649740119 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MASSONE | ||||||||
| FirstName: | MEGAN | ||||||||
| MiddleName: | |||||||||
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| Credential: | MA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 712 19TH ST APT A | ||||||||
| Address2: | |||||||||
| City: | PACIFIC GROVE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 939504108 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5104687878 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 299 12TH ST STE A | ||||||||
| Address2: | |||||||||
| City: | MARINA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 939336003 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8316477652 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/28/2018 | ||||||||
| LastUpdateDate: | 01/04/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/23/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106S00000X | 46-1305562 | CA | N | 390200000X | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.