Healthcare Provider Details

I. General information

NPI: 1356149025
Provider Name (Legal Business Name): SKINSATIONAL AESTHETICS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2025
Last Update Date: 03/06/2025
Certification Date: 03/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 TERRACINA BLVD
REDLANDS CA
92373-4850
US

IV. Provider business mailing address

PO BOX 9126
CANOGA PARK CA
91309-0126
US

V. Phone/Fax

Practice location:
  • Phone: 818-709-8161
  • Fax: 818-709-8160
Mailing address:
  • Phone: 818-709-8161
  • Fax: 818-709-8160

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: SAMEH MIKHAIL
Title or Position: OWNER, CEO, CFO
Credential: MD
Phone: 562-355-1918