Provider Demographics
NPI:1013754498
Name:THE SMOOTH SKIN CENTER
Entity type:Organization
Organization Name:THE SMOOTH SKIN CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:OLIVIA
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:JENKS
Authorized Official - Suffix:
Authorized Official - Credentials:LPE
Authorized Official - Phone:909-717-6069
Mailing Address - Street 1:6800 INDIANA AVE STE 205
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92506-4267
Mailing Address - Country:US
Mailing Address - Phone:704-274-0401
Mailing Address - Fax:
Practice Address - Street 1:6800 INDIANA AVE STE 205
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92506-4267
Practice Address - Country:US
Practice Address - Phone:909-717-6069
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-11
Last Update Date:2024-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center