Healthcare Provider Details

I. General information

NPI: 1689711244
Provider Name (Legal Business Name): ADVANCED SKINCARE MEDCENTER INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2007
Last Update Date: 10/30/2020
Certification Date: 10/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

369 SAN MIGUEL DR STE 235
NEWPORT BEACH CA
92660-7816
US

IV. Provider business mailing address

369 SAN MIGUEL DR STE 235
NEWPORT BEACH CA
92660-7816
US

V. Phone/Fax

Practice location:
  • Phone: 949-706-2887
  • Fax: 949-706-2846
Mailing address:
  • Phone: 949-706-2887
  • Fax: 949-706-2846

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER ALICE ARMSTRONG
Title or Position: OWNER
Credential: MD
Phone: 949-706-2887