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General NPI Number Information
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NPI Number | 1306637350
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Entity Type | Organization
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Legal Business Name | NUBLOOM PMMD PLLC
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Dates
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Enumeration Date | 05/16/2025
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Last Update Date | 05/16/2025
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Provider Practice Location Address
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Address Line | 14010 COUGAR PT
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City | SAN ANTONIO
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State | TX
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Zip | 78230-5924
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Country | US
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Telephone | 210-862-8652
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Fax |
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Provider Business Mailing Address
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Address Line | 674 WARMINSTER LN
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City | LITITZ
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State | PA
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Zip | 17543-5006
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Country | US
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Telephone | 717-341-9955
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | JENNIFER CUTILLO
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Credential |
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Telephone | 717-855-4300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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