Provider Demographics
NPI:1386791598
Name:MASON, GERALD EIZAN (L AC)
Entity type:Individual
Prefix:
First Name:GERALD
Middle Name:EIZAN
Last Name:MASON
Suffix:
Gender:M
Credentials:L AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12526 RIVERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:VALLEY VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91607-3409
Mailing Address - Country:US
Mailing Address - Phone:818-985-2559
Mailing Address - Fax:818-985-4459
Practice Address - Street 1:12526 RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:VALLEY VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91607-3409
Practice Address - Country:US
Practice Address - Phone:818-985-2559
Practice Address - Fax:818-985-4459
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 7667171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist