| Az Skin Sub Llc | |
|
10810 N Tatum Blvd Ste 102-132 Phoenix AZ 85028-6055 | |
| (480) 389-6863 | |
| (888) 819-9648 |
| Full Name | Az Skin Sub Llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 10810 N Tatum Blvd Ste 102-132, Phoenix, Arizona |
| Authorized Official Name and Position | Jarvis Tzeng (PRESIDENT) |
| Authorized Official Contact | 4803896863 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Az Skin Sub Llc 10810 N Tatum Blvd Ste 102-132 Phoenix AZ 85028-6055 Ph: (480) 389-6863 | Az Skin Sub Llc 10810 N Tatum Blvd Ste 102-132 Phoenix AZ 85028-6055 Ph: (480) 389-6863 |
| NPI Number | 1912618687 |
|---|---|
| Provider Enumeration Date | 12/13/2022 |
| Last Update Date | 12/13/2022 |
| Medicare PECOS PAC ID | 6800268152 |
|---|---|
| Medicare Enrollment ID | O20230712002830 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1912618687 | NPI | - | NPPES |
| 1811137722 | Medicaid | AZ |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | Jarvis A Tzeng |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1811137722 PECOS PAC ID: 4587858956 Enrollment ID: I20111003000703 |
| Provider Name | Octavia T Garcia |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1457967812 PECOS PAC ID: 3173934114 Enrollment ID: I20201124002089 |
| Provider Name | Anthony Babb |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1881186419 PECOS PAC ID: 5496142051 Enrollment ID: I20220428002275 |
| Provider Name | Jasmine Atchison-saari |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1205584992 PECOS PAC ID: 7315326469 Enrollment ID: I20220620001145 |
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