Advanced Skincare Physician Assistant Corporation (Pac)

Primary specialty

Physician AssistantTaxonomy code 363A00000X

Legal business name

ADVANCED SKINCARE PHYSICIAN ASSISTANT CORPORATION (PAC)

Practice address

2720 N Harbor Blvd Ste 230
Fullerton, CA 92835-2626

Phone

(714) 879-9936

NPI assigned

Oct 28, 2020

Last updated

Feb 8, 2021By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Suzanne Freesemann, PANPI 1285750430

Title

Ceo

Phone

(714) 879-9936

Specialties & licenses 1

Addresses

Other names 1

• Advanced SkinCare, PAC Former legal business name

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Suzanne Freesemann, P.A.

  • Physician Assistant
  • Fullerton, CA
  • NPI 1285750430
  Medicare reassignment Care Compare group Authorized official
• Marguerite Joanna Critelli, MD

  • Dermatology Physician
  • Newport Beach, CA
  • NPI 1902962954
  Medicare reassignment Care Compare group NPD
• Cole Marie Fulwider, M.D.

  • Dermatology Physician
  • Los Alamitos, CA
  • NPI 1033188560
  Medicare reassignment NPD

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

{
    "created_epoch": "1603843200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1612742400000",
    "number": "1245830389",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2720 N HARBOR BLVD STE 230",
            "city": "FULLERTON",
            "state": "CA",
            "postal_code": "928352626",
            "telephone_number": "714-879-9936"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2720 N HARBOR BLVD STE 230",
            "city": "FULLERTON",
            "state": "CA",
            "postal_code": "928352626",
            "telephone_number": "714-879-9936"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADVANCED SKINCARE PHYSICIAN ASSISTANT CORPORATION (PAC)",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-10-28",
        "last_updated": "2021-02-08",
        "certification_date": "2021-02-08",
        "status": "A",
        "authorized_official_last_name": "FREESEMANN",
        "authorized_official_first_name": "SUZANNE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "714-879-9936",
        "authorized_official_credential": "PA"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Advanced SkinCare, PAC",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "Advanced SkinCare, PAC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

• Advance Recovery Solution, LLC
• Advanced Fullerton Imaging, Inc.
• Advanced Healthcare Administration
• Advanced Memorial Imaging Group, a Medical Corporation
• Advanced Skincare Dermatology Inc
• Advanced Skincare, a Professional Corp.
• After Hours Acupuncture
• Vernon Sanford Agarth Jr., O.D.
• Adina Agent
• Katherynne Marjori Aggabao, RD

• Physician Assistant in Fullerton, CA
• Providers in Fullerton, CA by specialty
• Physician Assistant in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 8, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.