Provider Demographics
NPI:1124412952
Name:SKIN PERFECT WHITTIER
Entity Type:Organization
Organization Name:SKIN PERFECT WHITTIER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ERIN
Authorized Official - Middle Name:
Authorized Official - Last Name:BORINI
Authorized Official - Suffix:
Authorized Official - Credentials:MS, PA-C
Authorized Official - Phone:562-464-5777
Mailing Address - Street 1:3379 MARIGOLD CIR
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626-1724
Mailing Address - Country:US
Mailing Address - Phone:909-910-9696
Mailing Address - Fax:
Practice Address - Street 1:6501 GREENLEAF AVE
Practice Address - Street 2:
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90601-4108
Practice Address - Country:US
Practice Address - Phone:562-464-5777
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-18
Last Update Date:2015-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA17097261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center