Provider Demographics
NPI:1457904658
Name:ADVANCED SKIN CARE
Entity Type:Organization
Organization Name:ADVANCED SKIN CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANGIE
Authorized Official - Middle Name:
Authorized Official - Last Name:HARDEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-606-8667
Mailing Address - Street 1:3434 PRYTANIA ST STE 420
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70115-3502
Mailing Address - Country:US
Mailing Address - Phone:504-606-8667
Mailing Address - Fax:504-766-1384
Practice Address - Street 1:3434 PRYTANIA ST STE 420
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70115-3502
Practice Address - Country:US
Practice Address - Phone:504-606-8667
Practice Address - Fax:504-766-1384
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-17
Last Update Date:2019-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty