Provider Demographics
NPI:1710656491
Name:SKIN DEEP DERMAL ARTISTRY BY LEA
Entity Type:Organization
Organization Name:SKIN DEEP DERMAL ARTISTRY BY LEA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LEA
Authorized Official - Middle Name:
Authorized Official - Last Name:CLIFT
Authorized Official - Suffix:
Authorized Official - Credentials:LSA
Authorized Official - Phone:806-392-5216
Mailing Address - Street 1:7329 19TH ST
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79407-4301
Mailing Address - Country:US
Mailing Address - Phone:806-392-5216
Mailing Address - Fax:
Practice Address - Street 1:7329 19TH ST
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79407-4301
Practice Address - Country:US
Practice Address - Phone:806-392-5216
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-07
Last Update Date:2021-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty