The Smooth Skin Center

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

Legal business name

THE SMOOTH SKIN CENTER

Practice address

6800 Indiana Ave Ste 205
Riverside, CA 92506-4267

Phone

(909) 717-6069

NPI assigned

Jul 11, 2024

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Olivia Michelle Jenks, LPENPI 1427893767

Title

Ceo

Phone

(909) 717-6069

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Olivia Jenks, LPE

  • Procedural Dermatology Physician
  • Riverside, CA
  • NPI 1427893767
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1720656000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1720656000000",
    "number": "1013754498",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6800 INDIANA AVE STE 205",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "925064267",
            "telephone_number": "704-274-0401"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6800 INDIANA AVE STE 205",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "925064267",
            "telephone_number": "909-717-6069"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE SMOOTH SKIN CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-07-11",
        "last_updated": "2024-07-11",
        "certification_date": "2024-07-11",
        "status": "A",
        "authorized_official_last_name": "JENKS",
        "authorized_official_first_name": "OLIVIA",
        "authorized_official_middle_name": "MICHELLE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "909-717-6069",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "LPE"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Ellen Marie Theobald, PHD

• Clinic/Center in Riverside, CA
• Providers in Riverside, CA by specialty
• Clinic/Center in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 11, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.