REGENCY SKIN INSTITUTE PLLC NPI 1083298301

NPI Information

NPI: 1083298301
Provider Name: REGENCY SKIN INSTITUTE PLLC
Classification: Clinic/Center - 261QM1300X
Entity Type: Organization

Specialization: Multi-Specialty

CLIA Number: 03D2181604

Address:
14725 W MOUNTAIN VIEW BLVD
SURPRISE, AZ
ZIP 85374
Phone: (623) 243-9077
Get Directions

REGENCY SKIN INSTITUTE PLLC is a multi-specialty clinic center in Surprise, AZ. REGENCY SKIN INSTITUTE PLLC NPI is 1083298301. The provider is registered as an organization entity type.

The provider's business location address is:

14725 W MOUNTAIN VIEW BLVD
SURPRISE, AZ
ZIP 85374-704
Phone: (623) 243-9077

The provider's authorized official is Jason Lee Mussman .
The authorized official title is Owner and has the following contact phone number (623) 251-6431.

The CLIA number assigned to this NPI record is 03D2181604 - physician office with a certificate type of Certificate of Registration.

The enumeration date for this NPI number is 5/12/2021 and was last updated on 5/12/2021.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QM1300X	Clinic/Center	Multi-Specialty			Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	49090	OTHER	ARIZONA	ARIZONA MEDICAL BOARD

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

NPI Synchronization or Removal

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