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Organization

REGENCY SPA LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
JASON LEE MUSSMAN MD (OWNER)
(623) 243-9077
Entity
Organization

Contact information

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

Taxonomy

Speciality
Code
Description
License number
State
261QM2500X
Medical Specialty Clinic/Center
Primary

Other

Enumeration date
05/07/2021
Last updated
05/07/2021
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