# REGENCY SPA LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1548844343
- **Authorized official:** JASON LEE MUSSMAN MD (OWNER)
- **Authorized official phone:** (623) 243-9077

## Contact information

- **Practice address:** 14725 W MOUNTAIN VIEW BLVD, SURPRISE, AZ 85374-2704
- **Practice address phone:** (623) 243-9077
- **Mailing address:** 10240 W INDIAN SCHOOL RD STE 115, PHOENIX, AZ 85037-5905
- **Mailing address phone:** (623) 243-9077

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM2500X | Medical Specialty Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 05/07/2021
- **Last updated:** 05/07/2021