Restore Medical Spa, LLC

Primary specialty

Medical Specialty Clinic/CenterTaxonomy code 261QM2500X

Legal business name

RESTORE MEDICAL SPA, LLC

Practice address

3500 Constitution Ave NE
Albuquerque, NM 87106-1215

Phone

(505) 814-1995

Fax

(505) 433-5127

NPI assigned

Oct 19, 2022

Organization subpart

No

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

Authorized official

Name

Victoria Gallegos

Title

Director

Phone

(505) 281-5180

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1666137600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1666137600000",
    "number": "1487370573",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12127B N STATE HWY 14 STE 5",
            "city": "CEDAR CREST",
            "state": "NM",
            "postal_code": "870089557",
            "telephone_number": "505-281-5180",
            "fax_number": "505-281-5320"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3500 CONSTITUTION AVE NE",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871061215",
            "telephone_number": "505-814-1995",
            "fax_number": "505-433-5127"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RESTORE MEDICAL SPA, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-10-19",
        "last_updated": "2022-10-19",
        "certification_date": "2022-10-19",
        "status": "A",
        "authorized_official_last_name": "GALLEGOS",
        "authorized_official_first_name": "VICTORIA",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "505-281-5180"
    },
    "taxonomies": [
        {
            "code": "261QM2500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Medical Specialty",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Medical Specialty Clinic/Center in Albuquerque, NM
• Providers in Albuquerque, NM by specialty
• Medical Specialty Clinic/Center in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 19, 2022; 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.