Healthcare Provider Details

I. General information

NPI: 1093032658
Provider Name (Legal Business Name): HADAS SKUPSKY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/22/2010
Last Update Date: 12/18/2024
Certification Date: 12/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3828 SCHAUFELE AVE STE 300
LONG BEACH CA
90808-1793
US

IV. Provider business mailing address

3828 SCHAUFELE AVE STE 300
LONG BEACH CA
90808-1793
US

V. Phone/Fax

Practice location:
  • Phone: 562-997-1144
  • Fax: 562-989-3612
Mailing address:
  • Phone: 562-997-1144
  • Fax: 562-989-3612

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License NumberA120077
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License NumberA120077
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: