1700114303 NPI number — ADVANCED SKINCARE SURGERY CENTER

Table of content: (NPI 1700114303)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700114303 NPI number — ADVANCED SKINCARE SURGERY CENTER

Organization/Personal Information

Employer Identification Number (EIN):
N/A
Provider Organization Name:
ADVANCED SKINCARE SURGERY CENTER
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1700114303
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/13/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
301 W BASTANCHURY RD
Provider Second Line Business Mailing Address:
SUITE 215
Provider Business Mailing Address City Name:
FULLERTON
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92835-3419
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
714-879-9936
Provider Business Mailing Address Fax Number:
714-879-3035

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
301 W BASTANCHURY RD
Provider Second Line Business Practice Location Address:
SUITE 240
Provider Business Practice Location Address City Name:
FULLERTON
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92835-3419
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
714-879-9936
Provider Business Practice Location Address Fax Number:
714-879-3035
Provider Enumeration Date:
11/20/2009

Additional Information

Authorized Official

Authorized Official Last Name:
SCHULTZ
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
Authorized Official Title or Position:
BILLING DIRECTOR
Authorized Official Telephone Number:
714-879-9936

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X , with the licence number:  C1202500 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com