Individual
MARK NUNZIO MASOTTO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
431 S BATAVIA ST, STE. 103, ORANGE, CA 92868-3936
(714) 538-6731
(714) 771-8369
Mailing address
PO BOX 14005, ORANGE, CA 92863-1405
(714) 571-5000
(714) 571-5055
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
A61275
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00A612750
BLUE SHIELD OF CA
—
05
—
00A612750
—
CA
01
—
00A612750 159
CALOPTIMA
—
01
—
053304CH71589
TRAILBLAZER
—
01
—
300136609
RAILROAD MEDICARE
—
Enumeration date
07/19/2005
Last updated
08/15/2008
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