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General NPI Number Information
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NPI Number | 1366334310
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Entity Type | Organization
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Legal Business Name | ADVANCED SKINCARE DERMATOLOGY INC
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Dates
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Enumeration Date | 07/16/2025
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Last Update Date | 07/16/2025
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Provider Practice Location Address
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Address Line | 2720 N HARBOR BLVD STE 230
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City | FULLERTON
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State | CA
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Zip | 92835-2626
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Country | US
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Telephone | 714-879-9936
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Fax | 714-750-9650
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Provider Business Mailing Address
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Address Line | 2720 N HARBOR BLVD STE 230
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City | FULLERTON
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State | CA
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Zip | 92835-2626
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Country | US
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Telephone | 714-879-9936
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Fax | 714-750-9650
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Authorized Official
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Title or Position | CEO
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Name | SUZANNE FREESEMANN
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Credential | PA-C
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Telephone | 714-879-9936
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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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 | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number |
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License Number State |
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