Healthcare Provider Details

I. General information

NPI: 1043119340
Provider Name (Legal Business Name): THE PETROGLYPHS MEDICAL SPA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2026
Last Update Date: 11/03/2026
Certification Date: 11/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9960 STONE CT NW
ALBUQUERQUE NM
87114-4109
US

IV. Provider business mailing address

9960 STONE CT NW
ALBUQUERQUE NM
87114-4109
US

V. Phone/Fax

Practice location:
  • Phone: 505-328-8117
  • Fax: 833-901-4819
Mailing address:
  • Phone: 505-328-8117
  • Fax: 833-901-4819

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. JACQUELINE ANNE RODWICK
Title or Position: OWNER
Credential:
Phone: 505-328-8117