Provider Demographics
NPI:1063131555
Name:WINHAM-FLETCHER, MASON LUCIAN CHESLEY V
Entity type:Individual
Prefix:
First Name:MASON
Middle Name:LUCIAN CHESLEY
Last Name:WINHAM-FLETCHER
Suffix:V
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 CIRCLE DR
Mailing Address - Street 2:
Mailing Address - City:BEN LOMOND
Mailing Address - State:CA
Mailing Address - Zip Code:95005
Mailing Address - Country:US
Mailing Address - Phone:925-584-8873
Mailing Address - Fax:
Practice Address - Street 1:290 CIRCLE DR
Practice Address - Street 2:
Practice Address - City:BEN LOMOND
Practice Address - State:CA
Practice Address - Zip Code:95005
Practice Address - Country:US
Practice Address - Phone:925-584-8873
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-26
Last Update Date:2023-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker