Healthcare Provider Details

I. General information

NPI: 1194422832
Provider Name (Legal Business Name): TWILIGHT PHYSICIAN GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2023
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4600 MCLEOD RD NE
ALBUQUERQUE NM
87109-2106
US

IV. Provider business mailing address

4600 MCLEOD RD NE
ALBUQUERQUE NM
87109-2106
US

V. Phone/Fax

Practice location:
  • Phone: 505-532-1020
  • Fax: 505-494-1515
Mailing address:
  • Phone: 505-532-1020
  • Fax: 505-494-1515

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DENISE IRWIN-PODLESNY
Title or Position: FOUNDER
Credential: RN
Phone: 505-512-1880