Healthcare Provider Details

I. General information

NPI: 1851870208
Provider Name (Legal Business Name): SKIN WORKS INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2018
Last Update Date: 08/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2573 PACIFIC COAST HWY STE B
TORRANCE CA
90505
US

IV. Provider business mailing address

2573 PACIFIC COAST HWY STE B
TORRANCE CA
90505-7950
US

V. Phone/Fax

Practice location:
  • Phone: 424-488-6399
  • Fax:
Mailing address:
  • Phone: 424-250-1680
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number028306
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number028306
License Number StateCA

VIII. Authorized Official

Name: STEPHANIE DURRETT
Title or Position: OFFICE MANAGER
Credential:
Phone: 424-352-0049