| Regency Skin Institute Pllc | |
|
14725 W Mountain View Blvd Surprise AZ 85374-2704 | |
| (623) 243-9077 | |
| Not Available |
| Full Name | Regency Skin Institute Pllc |
|---|---|
| Speciality | Clinic/center - Multi-specialty |
| Location | 14725 W Mountain View Blvd, Surprise, Arizona |
| Authorized Official Name and Position | Jason Lee Mussman (OWNER) |
| Authorized Official Contact | 6232516431 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Regency Skin Institute Pllc 14725 W Mountain View Blvd Surprise AZ 85374-2704 Ph: (623) 243-9077 | Regency Skin Institute Pllc 14725 W Mountain View Blvd Surprise AZ 85374-2704 Ph: (623) 243-9077 |
| NPI Number | 1083298301 |
|---|---|
| Provider Enumeration Date | 05/12/2021 |
| Last Update Date | 05/12/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1083298301 | NPI | - | NPPES |
| 49090 | Other | AZ | ARIZONA MEDICAL BOARD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Primary |
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