Provider Demographics
NPI:1215067558
Name:MASTERS, COLLEEN (PHD)
Entity type:Individual
Prefix:DR
First Name:COLLEEN
Middle Name:
Last Name:MASTERS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 MONARCH BAY PLAZA
Mailing Address - Street 2:SUITE N
Mailing Address - City:DANA POINT
Mailing Address - State:CA
Mailing Address - Zip Code:92629-1917
Mailing Address - Country:US
Mailing Address - Phone:949-489-8005
Mailing Address - Fax:
Practice Address - Street 1:28 MONARCH BAY PLAZA
Practice Address - Street 2:SUITE N
Practice Address - City:DANA POINT
Practice Address - State:CA
Practice Address - Zip Code:92629-1917
Practice Address - Country:US
Practice Address - Phone:949-489-8005
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY15609103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACP15609Medicare ID - Type Unspecified