Healthcare Provider Details

I. General information

NPI: 1134870595
Provider Name (Legal Business Name): HAPPY SKIN PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2022
Last Update Date: 01/17/2022
Certification Date: 01/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3201 W PEORIA AVE STE A105
PHOENIX AZ
85029-4609
US

IV. Provider business mailing address

14030 N 20TH ST
PHOENIX AZ
85022-4678
US

V. Phone/Fax

Practice location:
  • Phone: 602-837-3376
  • Fax: 949-955-4657
Mailing address:
  • Phone: 602-499-2362
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207NP0225X
TaxonomyPediatric Dermatology Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. SAMANTHA BAE CASSELMAN
Title or Position: PNP, OWNER
Credential: DNP
Phone: 602-499-2362