Healthcare Provider Details

I. General information

NPI: 1669206462
Provider Name (Legal Business Name): SKIN SAVVY MEDICAL GROUP INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2024
Last Update Date: 08/27/2024
Certification Date: 08/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

49 PIER AVE STE 2A
HERMOSA BEACH CA
90254-3776
US

IV. Provider business mailing address

860 HAMPSHIRE RD STE I
WESTLAKE VILLAGE CA
91361-6019
US

V. Phone/Fax

Practice location:
  • Phone: 310-561-5030
  • Fax:
Mailing address:
  • Phone: 805-630-6124
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code1223P0106X
TaxonomyOral and Maxillofacial Pathology Dentistry
License Number
License Number State

VIII. Authorized Official

Name: MRS. BREE GLANTZ
Title or Position: VP OF OPERATIONS
Credential:
Phone: 805-630-6124