BLACK DIAMOND MED SPA (NPI# 1932585965) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1932585965 |
| Entity Type | Organization |
| Organization Name | BLACK DIAMOND MED SPA |
| Practice Address |
18730 Stone Oak Pkwy Ste 106 San Antonio TX 78258-4140 |
| Practice Telephone | 2104032552 |
| Practice Fax Number | 2104032144 |
| Mailing Telephone | 2104032552 |
| Mailing Fax Number | 2104032144 |
| Enumeration Date | 2015-07-31 |
| Last Update Date | 2015-07-31 |
| Authorized Official Name | MR. JONAS CRAFTS (MANAGER) |
| Authorized Official Telephone | 2104032552 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LF0000X |
Nurse Practitioner Specialization: Family |
Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
18730 STONE OAK PKWY STE 106 |
| City | SAN ANTONIO |
| State | TX |
| Zip Code | 78258-4140 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1508891615 | Mark Anthony Porter | Dentist | 18730 Stone Oak Pkwy, Suite 200, San Antonio, TX 78258-4140 | 2006-07-11 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356980163 | Jeffrey M. Martinez, M.d., P.a. | Surgery | 525 Centre Oak Drive, Suite 140, San Antonio, TX 78258 | 2019-12-26 |
| 1588226211 | New Life Brace and Limb, LLC | Prosthetist | 300 E. Sonterra Blvd., Suite 220, San Antonio, TX 78258 | 2019-07-02 |
| 1720649080 | Miguel Ibarra | Pharmacist | 18866 Stone Oak Pkwy., St.101, San Antonio, TX 78258 | 2019-06-26 |
| 1528538113 | Kevin Scott Farnsworth | Dentist | 1130 E. Sonterra Blvd Suite 100, San Antonio, TX 78258 | 2018-11-27 |
| 1891262176 | Dentists of Stone Oak, PC | Dentist | 23714 Hardy Oak Blvd, Suite 110, San Antonio, TX 78258 | 2018-10-25 |
| 1003399437 | Jesus Alcala | Physical Therapist | 20821 Us Hwy 281 N, Ste 110, San Antonio, TX 78258 | 2018-09-11 |
| 1184106544 | Marissa Kaye Bruton | Occupational Therapist | 505 Madison Oak, San Antonio, TX 78258 | 2018-09-02 |
| 1508346933 | Desiree Carroll | Occupational Therapy Assistant | 18803 Hardy Oak Drive, San Antonio, TX 78258 | 2018-08-15 |
| 1700376456 | Conner Jay Mcnabb | Optometrist | 810 Knights Cross Dr Ste 101, San Antonio, TX 78258 | 2018-05-17 |
| 1982191516 | Freehand Solutions LLC | Chiropractor | Nec Stone Oak Parkway & Loop 1604, San Antonio, TX 78258 | 2018-04-19 |
| Find all providers in zip 78258 | ||||
| Taxonomy Code | 363LF0000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Family |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1184224834 | Natasha Bakunda | Nurse Practitioner | Fountainhead One Tower, 8200 Ih-10 West, Ste 317, San Antonio, TX 78230 | 2020-10-30 |
| 1033719521 | Macy Atkins | Nurse Practitioner | 6676 Utsa Blvd, San Antonio, TX 78249-5100 | 2020-10-26 |
| 1801494554 | Yordanis Rafael Fonseca Vega | Nurse Practitioner | 12521 Nacogdoches Rd Ste 101, San Antonio, TX 78217-2117 | 2020-10-14 |
| 1255939237 | Ashley Elizabeth Swartz | Nurse Practitioner | 9502 Huebner Rd Ste 101, San Antonio, TX 78240-1683 | 2020-10-13 |
| 1871190173 | Cynthia B Elkins | Nurse Practitioner | 24806 Terlingua Bnd, San Antonio, TX 78261-2726 | 2020-10-08 |
| 1588270623 | Amanda Razo | Nurse Practitioner | 6315 Welles Arbor Cir, San Antonio, TX 78240-2148 | 2020-09-23 |
| 1255946935 | Norberto Hernandez Iv | Nurse Practitioner | 11501 Braesview Apt 3903, San Antonio, TX 78213-1262 | 2020-09-10 |
| 1033723655 | Hira Mughal | Nurse Practitioner | 9850 Twinbear Crk, San Antonio, TX 78245-9596 | 2020-09-01 |
| 1366055675 | Maria Christina Cruz Tijerina | Nurse Practitioner | 18518 Hardy Oak Blvd Apt 135, San Antonio, TX 78258-4759 | 2020-08-26 |
| 1225649593 | Gina M Duron | Nurse Practitioner | 10730 Green Trail Dr, San Antonio, TX 78223-4224 | 2020-08-11 |
| Find all providers in SAN ANTONIO | ||||
| City | SAN ANTONIO |
| Zip Code | 78258 |
Please comment or provide details below to improve the information on BLACK DIAMOND MED SPA.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.