Provider Demographics
NPI:1134870595
Name:HAPPY SKIN PLLC
Entity type:Organization
Organization Name:HAPPY SKIN PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PNP, OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SAMANTHA
Authorized Official - Middle Name:BAE
Authorized Official - Last Name:CASSELMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DNP
Authorized Official - Phone:602-499-2362
Mailing Address - Street 1:14030 N 20TH ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85022-4678
Mailing Address - Country:US
Mailing Address - Phone:602-499-2362
Mailing Address - Fax:
Practice Address - Street 1:3201 W PEORIA AVE STE A105
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85029-4609
Practice Address - Country:US
Practice Address - Phone:602-837-3376
Practice Address - Fax:949-955-4657
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-17
Last Update Date:2022-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207NP0225XAllopathic & Osteopathic PhysiciansDermatologyPediatric DermatologyGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ3476860446Medicaid