Provider Demographics
NPI:1396070512
Name:MASON, LEONA ROSE (FNP)
Entity type:Individual
Prefix:
First Name:LEONA
Middle Name:ROSE
Last Name:MASON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:14445 OLIVE VIEW DRIVE ROOM 6B119H
Mailing Address - Street 2:OLIVE VIEW UCLA MEDICAL CENTER MEDICAL STAFF OFFICE
Mailing Address - City:SYLMAR
Mailing Address - State:CA
Mailing Address - Zip Code:91342
Mailing Address - Country:US
Mailing Address - Phone:818-364-3205
Mailing Address - Fax:
Practice Address - Street 1:14445 OLIVE VIEW DRIVE ROOM 6B119H
Practice Address - Street 2:OLIVE VIEW UCLA MEDICAL CENTER MEDICAL STAFF OFFICE
Practice Address - City:SYLMAR
Practice Address - State:CA
Practice Address - Zip Code:91342
Practice Address - Country:US
Practice Address - Phone:818-364-3205
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-06
Last Update Date:2011-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR174895363LF0000X
CA18607363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily