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General NPI Number Information
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NPI Number | 1629963780
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Entity Type | Organization
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Legal Business Name | BLACK-PEARL MEDICAL LLC
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Dates
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Enumeration Date | 06/10/2025
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Last Update Date | 09/09/2025
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Provider Practice Location Address
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Address Line | 12407 WALTHAMPTON ST
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City | SAN ANTONIO
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State | TX
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Zip | 78216-2944
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Country | US
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Telephone | 316-992-0034
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Fax |
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Provider Business Mailing Address
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Address Line | 12407 WALTHAMPTON ST
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City | SAN ANTONIO
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State | TX
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Zip | 78216-2944
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JULIET GATOBU
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Credential | NURSE PRACTITIONER
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Telephone | 316-992-0034
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305S00000X
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Taxonomy Name | Point of Service
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License Number |
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License Number State |
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