Provider Demographics
NPI:1255104394
Name:MASONGSONG, VERNON (MHP)
Entity type:Individual
Prefix:MR
First Name:VERNON
Middle Name:
Last Name:MASONGSONG
Suffix:
Gender:M
Credentials:MHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1327 DA VINCI DR
Mailing Address - Street 2:
Mailing Address - City:SAN JACINTO
Mailing Address - State:CA
Mailing Address - Zip Code:92583-5253
Mailing Address - Country:US
Mailing Address - Phone:951-426-8540
Mailing Address - Fax:
Practice Address - Street 1:1327 DA VINCI DR
Practice Address - Street 2:
Practice Address - City:SAN JACINTO
Practice Address - State:CA
Practice Address - Zip Code:92583-5253
Practice Address - Country:US
Practice Address - Phone:951-426-8540
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-31
Last Update Date:2023-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171400000XOther Service ProvidersHealth & Wellness CoachGroup - Single Specialty