Provider Demographics
NPI:1306637350
Name:NUBLOOM PMMD PLLC
Entity type:Organization
Organization Name:NUBLOOM PMMD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:CUTILLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-855-4300
Mailing Address - Street 1:674 WARMINSTER LN
Mailing Address - Street 2:
Mailing Address - City:LITITZ
Mailing Address - State:PA
Mailing Address - Zip Code:17543-5006
Mailing Address - Country:US
Mailing Address - Phone:717-341-9955
Mailing Address - Fax:
Practice Address - Street 1:14010 COUGAR PT
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78230-5924
Practice Address - Country:US
Practice Address - Phone:210-862-8652
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-16
Last Update Date:2025-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty