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General NPI Number Information
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NPI Number | 1497270664
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Entity Type | Organization
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Legal Business Name | SKIN CONCIERGE, LLC.
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Dates
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Enumeration Date | 08/09/2017
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Last Update Date | 03/30/2023
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Provider Practice Location Address
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Address Line | 1310 W. ST. MARY'S ROAD 2ND FLOOR, SUITE A
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City | TUCSON
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State | AZ
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Zip | 85745
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Country | US
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Telephone | 520-333-5973
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Fax | 520-221-2318
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Provider Business Mailing Address
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Address Line | 1310 W SAINT MARYS RD STE A
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City | TUCSON
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State | AZ
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Zip | 85745-3231
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Country | US
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Telephone | 520-333-5973
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Fax | 520-221-2318
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Authorized Official
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Title or Position | PRACTICE MANAGER
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Name | DESTINY GYPSYLEE MATTOX
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Credential |
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Telephone | 520-333-5973
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207NI0002X
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Taxonomy Name | Clinical & Laboratory Dermatological Immunology Physician
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License Number |
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License Number State |
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