Healthcare Provider Details

I. General information

NPI: 1568031995
Provider Name (Legal Business Name): ASPIRE SKIN HEALTH, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2021
Last Update Date: 12/31/2023
Certification Date: 12/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 CROWN POINTE BLVD STE 300
WILLOW PARK TX
76087-1309
US

IV. Provider business mailing address

211 CROWN POINTE BLVD STE 300
WILLOW PARK TX
76087-1309
US

V. Phone/Fax

Practice location:
  • Phone: 817-482-0000
  • Fax:
Mailing address:
  • Phone: 817-482-0000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZD0900X
TaxonomyDermatopathology (Pathology) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: CAMERAN NGUYEN
Title or Position: PHYSICIAN
Credential: DO
Phone: 817-482-0000