Organization
AGELESS MEDICAL SPA - CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MISS MARILA TAYLOR NP (OWNER)
(915) 929-6369
Entity
Organization
Contact information
Practice address
3961 E LOHMAN AVE, SUITE 12, LAS CRUCES, NM 88011-8269
(575) 521-4888
(575) 521-4888
Mailing address
3961 E LOHMAN AVE, SUITE 12, LAS CRUCES, NM 88011-8269
(575) 521-4888
(575) 521-4888
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
CNP02129
NM
363LW0102X
Women's Health Nurse Practitioner
CNP02155
NM
Other
Enumeration date
09/11/2013
Last updated
09/19/2013
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