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General NPI Number Information
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NPI Number | 1043119340
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Entity Type | Organization
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Legal Business Name | THE PETROGLYPHS MEDICAL SPA
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Dates
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Enumeration Date | 11/03/2026
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Last Update Date | 11/03/2026
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Provider Practice Location Address
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Address Line | 9960 STONE CT NW
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City | ALBUQUERQUE
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State | NM
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Zip | 87114-4109
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Country | US
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Telephone | 505-328-8117
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Fax | 833-901-4819
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Provider Business Mailing Address
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Address Line | 9960 STONE CT NW
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City | ALBUQUERQUE
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State | NM
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Zip | 87114-4109
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Country | US
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Telephone | 505-328-8117
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Fax | 833-901-4819
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Authorized Official
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Title or Position | OWNER
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Name | DR. JACQUELINE ANNE RODWICK
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Credential |
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Telephone | 505-328-8117
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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