Healthcare Provider Details

I. General information

NPI: 1588512271
Provider Name (Legal Business Name): NEW MOON REJUVENATING MED SPA AND CONCIERGE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/18/2026
Last Update Date: 03/18/2026
Certification Date: 03/18/2026
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: 505-333-8655
  • Fax:
Mailing address:
  • Phone: 505-333-8655
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DENISE IRWIN-PODLESNY
Title or Position: OWNER
Credential: RN
Phone: 505-333-8655