Theophilus Mason, FNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

NP95029519 Issued in CA

Practice address

250 W Bonita Ave Ste 100
Pomona, CA 91767-1863

Phone

(909) 392-2002

Fax

(626) 795-4768

NPI assigned

Feb 4, 2022

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other names 1

• Theophilus Mason Other name

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Kylie Fuller MD Inc

  • Obstetrics & Gynecology Physician
  • Pomona, CA
  • NPI 1891473872
  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1643932800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1733961600000",
    "number": "1205580701",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "250 W BONITA AVE STE 100",
            "city": "POMONA",
            "state": "CA",
            "postal_code": "917671863",
            "telephone_number": "909-392-2002",
            "fax_number": "626-795-4768"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "250 W BONITA AVE STE 100",
            "city": "POMONA",
            "state": "CA",
            "postal_code": "917671863",
            "telephone_number": "909-392-2002",
            "fax_number": "626-795-4768"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MASON",
        "first_name": "THEOPHILUS",
        "credential": "FNP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-02-04",
        "last_updated": "2024-12-12",
        "certification_date": "2024-12-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IL",
            "license": "209023392",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CA",
            "license": "NP95029519",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "THEOPHILUS",
            "last_name": "MASON",
            "credential": "FNP",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Jonathan Blic Arpon Masayon, LVN
• Daniel Zachary Mashiach
• Khaneal Javon Mason
• Lauren Simone Mason
• Nicole Marie Mason, CATC-II
• Neema Masoudipour
• Sierra Nicole Masson
• Jasmine Kassandra Mata
• Michelle Mata
• Michelle Lauren Mata, MSW

• Family Nurse Practitioner in Pomona, CA
• Providers in Pomona, CA by specialty
• Family Nurse Practitioner in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 12, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.