# RESTORE MEDICAL SPA, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1487370573
- **Authorized official:** VICTORIA GALLEGOS (DIRECTOR)
- **Authorized official phone:** (505) 281-5180

## Contact information

- **Practice address:** 3500 CONSTITUTION AVE NE, ALBUQUERQUE, NM 87106-1215
- **Practice address phone:** (505) 814-1995
- **Practice address fax:** (505) 433-5127
- **Mailing address:** 12127B N STATE HWY 14 STE 5, CEDAR CREST, NM 87008-9557
- **Mailing address phone:** (505) 281-5180
- **Mailing address fax:** (505) 281-5320

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM2500X | Medical Specialty Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 10/19/2022
- **Last updated:** 10/19/2022