Regency Spa LLC

Primary specialty

Medical Specialty Clinic/CenterTaxonomy code 261QM2500X

Legal business name

REGENCY SPA LLC

Practice address

14725 W Mountain View Blvd
Surprise, AZ 85374-2704

Phone

(623) 243-9077

NPI assigned

May 7, 2021

Organization subpart

No

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

Authorized official

Name

Jason Lee Mussman, MD

Title

Owner

Phone

(623) 243-9077

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1620345600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1620345600000",
    "number": "1548844343",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10240 W INDIAN SCHOOL RD STE 115",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850375905",
            "telephone_number": "623-243-9077"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14725 W MOUNTAIN VIEW BLVD",
            "city": "SURPRISE",
            "state": "AZ",
            "postal_code": "853742704",
            "telephone_number": "623-243-9077"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REGENCY SPA LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-05-07",
        "last_updated": "2021-05-07",
        "certification_date": "2021-05-07",
        "status": "A",
        "authorized_official_last_name": "MUSSMAN",
        "authorized_official_first_name": "JASON",
        "authorized_official_middle_name": "LEE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "623-243-9077",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QM2500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Medical Specialty",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Reflexion Medical Rejuvenation Center PLLC
• Anamaria Regalado, EDS
• Regency Ambulatory Surgery Center One
• Regency Ambulatory Surgery Center One, LLC
• Regency Skin Institute PLLC
• Regulators Transportation
• Brooke Rehm
• Abbigale Rae Rehurek
• Amy Reiland, RD
• Zachary Reineke, BCBA - LBA

• Medical Specialty Clinic/Center in Surprise, AZ
• Providers in Surprise, AZ by specialty
• Medical Specialty Clinic/Center in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 7, 2021; 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.