Organization
BLACK-PEARL MEDICAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JULIET GATOBU NURSE PRACTITIONER (OWNER)
(316) 992-0034
Entity
Organization
Contact information
Practice address
12407 WALTHAMPTON ST, SAN ANTONIO, TX 78216-2944
(316) 992-0034
Mailing address
12407 WALTHAMPTON ST, SAN ANTONIO, TX 78216-2944
Taxonomy
Speciality
Code
Description
License number
State
305S00000X
Point of Service
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1629963780
—
TX
Enumeration date
06/10/2025
Last updated
09/09/2025
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