Provider Demographics
NPI:1700114303
Name:ADVANCED SKINCARE SURGERY CENTER
Entity Type:Organization
Organization Name:ADVANCED SKINCARE SURGERY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:ALICE
Authorized Official - Last Name:ARMSTRONG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-706-2887
Mailing Address - Street 1:369 SAN MIGUEL DR STE 235
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-7816
Mailing Address - Country:US
Mailing Address - Phone:949-706-2887
Mailing Address - Fax:949-706-2846
Practice Address - Street 1:369 SAN MIGUEL DR STE 235
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-7816
Practice Address - Country:US
Practice Address - Phone:949-706-2887
Practice Address - Fax:949-706-2846
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ADVANCED SKINCARE MEDCENTER INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-11-20
Last Update Date:2020-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC1202500261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW14185Medicare PIN