Provider Demographics
NPI:1932829579
Name:MASON, HAILEY AMANDA (PA)
Entity type:Individual
Prefix:
First Name:HAILEY
Middle Name:AMANDA
Last Name:MASON
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:4275 MISSION BAY DR APT 316
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92109-5764
Mailing Address - Country:US
Mailing Address - Phone:626-483-0299
Mailing Address - Fax:
Practice Address - Street 1:6136 LAKE MURRAY BLVD
Practice Address - Street 2:
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942-2502
Practice Address - Country:US
Practice Address - Phone:877-693-6266
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-02
Last Update Date:2024-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA64486363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant