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General NPI Number Information
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NPI Number | 1134870595
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Entity Type | Organization
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Legal Business Name | HAPPY SKIN PLLC
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Dates
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Enumeration Date | 01/17/2022
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Last Update Date | 01/17/2022
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Provider Practice Location Address
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Address Line | 3201 W PEORIA AVE STE A105
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City | PHOENIX
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State | AZ
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Zip | 85029-4609
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Country | US
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Telephone | 602-837-3376
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Fax | 949-955-4657
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Provider Business Mailing Address
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Address Line | 14030 N 20TH ST
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City | PHOENIX
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State | AZ
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Zip | 85022-4678
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Country | US
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Telephone | 602-499-2362
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Fax |
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Authorized Official
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Title or Position | PNP, OWNER
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Name | MRS. SAMANTHA BAE CASSELMAN
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Credential | DNP
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Telephone | 602-499-2362
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207NP0225X
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Taxonomy Name | Pediatric Dermatology Physician
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License Number |
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License Number State |
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