Provider Demographics
NPI:1538991575
Name:MASIOGE, SCHOLASTICA
Entity type:Individual
Prefix:
First Name:SCHOLASTICA
Middle Name:
Last Name:MASIOGE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 INLAND EMPIRE BLVD UNIT 4114
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91764-0800
Mailing Address - Country:US
Mailing Address - Phone:480-758-2110
Mailing Address - Fax:
Practice Address - Street 1:1900 INLAND EMPIRE BLVD UNIT 4114
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91764-0800
Practice Address - Country:US
Practice Address - Phone:480-758-2110
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-19
Last Update Date:2024-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN95125328163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral PracticeGroup - Single Specialty