Healthcare Provider Details

I. General information

NPI: 1366334310
Provider Name (Legal Business Name): ADVANCED SKINCARE DERMATOLOGY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2025
Last Update Date: 07/16/2025
Certification Date: 07/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2720 N HARBOR BLVD STE 230
FULLERTON CA
92835-2626
US

IV. Provider business mailing address

2720 N HARBOR BLVD STE 230
FULLERTON CA
92835-2626
US

V. Phone/Fax

Practice location:
  • Phone: 714-879-9936
  • Fax: 714-750-9650
Mailing address:
  • Phone: 714-879-9936
  • Fax: 714-750-9650

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name: SUZANNE FREESEMANN
Title or Position: CEO
Credential: PA-C
Phone: 714-879-9936