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General NPI Number Information
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NPI Number | 1730918848
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Entity Type | Individual
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Provider Name | DAVID DILLARD BLACKERBY II CNC
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Gender | Male
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Dates
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Enumeration Date | 07/29/2024
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Last Update Date | 01/10/2025
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Provider Practice Location Address
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Address Line | 3501 PIN OAK DR APT 1506
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City | SAN ANTONIO
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State | TX
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Zip | 78229-3032
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Country | US
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Telephone | 210-238-4873
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Fax |
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Provider Business Mailing Address
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Address Line | 3501 PIN OAK DR APT 1506
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City | SAN ANTONIO
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State | TX
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Zip | 78229-3032
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Country | US
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Telephone | 210-238-4873
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 146N00000X
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Taxonomy Name | Basic Emergency Medical Technician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 171W00000X
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Taxonomy Name | Contractor
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License Number |
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 172A00000X
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Taxonomy Name | Driver
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License Number | 22130577
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License Number State | TX
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Taxonomy #4
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Taxonomy Code | 3747P1801X
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Taxonomy Name | Personal Care Attendant
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 374U00000X
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Taxonomy Name | Home Health Aide
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 3747A0650X
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Taxonomy Name | Attendant Care Provider
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License Number |
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License Number State |
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