Organization
BLACK DIAMOND MEDICAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TONIA LANETTE GRAHAM (CO-OWNER)
(623) 322-0099
Entity
Organization
Contact information
Practice address
20449 N LAKE PLEASANT RD STE 101, PEORIA, AZ 85382-2707
(623) 322-0099
Mailing address
20449 N LAKE PLEASANT RD STE 101, PEORIA, AZ 85382-2707
(623) 322-0099
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
261QU0200X
Urgent Care Clinic/Center
—
—
363LP2300X
Primary Care Nurse Practitioner
Primary
—
—
Other
Enumeration date
10/12/2018
Last updated
03/06/2020
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