Healthcare Provider Details

I. General information

NPI: 1831817758
Provider Name (Legal Business Name): BLISS AESTHETICS MEDICAL SPA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2022
Last Update Date: 12/05/2022
Certification Date: 12/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2919 N CLIFFWOOD CIR
HOBBS NM
88240-2573
US

IV. Provider business mailing address

2919 N CLIFFWOOD CIR
HOBBS NM
88240-2573
US

V. Phone/Fax

Practice location:
  • Phone: 575-318-1068
  • Fax:
Mailing address:
  • Phone: 575-318-1068
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083B0002X
TaxonomyObesity Medicine (Preventive Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. MIRANDA LEE YOUNG
Title or Position: OWNER
Credential: FNP
Phone: 575-318-1068