Healthcare Provider Details

I. General information

NPI: 1023857984
Provider Name (Legal Business Name): SKINHAPPY MD CA PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2024
Last Update Date: 06/12/2024
Certification Date: 06/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

502 PIERCE ST
MONTEREY CA
93940-2621
US

IV. Provider business mailing address

502 PIERCE ST
MONTEREY CA
93940-2621
US

V. Phone/Fax

Practice location:
  • Phone: 831-747-1889
  • Fax:
Mailing address:
  • Phone: 831-747-1889
  • Fax: 831-855-0111

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State

VIII. Authorized Official

Name: JULIE KENNER
Title or Position: CEO
Credential:
Phone: 831-747-1889