Provider Demographics
NPI:1922483205
Name:PRIVILEGE, LLC
Entity Type:Organization
Organization Name:PRIVILEGE, LLC
Other - Org Name:BLUE DIAMOND MED SPA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JONAS
Authorized Official - Middle Name:
Authorized Official - Last Name:CRAFTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-494-2820
Mailing Address - Street 1:104 GALLERY CIR
Mailing Address - Street 2:STE 126
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-3329
Mailing Address - Country:US
Mailing Address - Phone:210-494-2820
Mailing Address - Fax:210-494-2002
Practice Address - Street 1:104 GALLERY CIR
Practice Address - Street 2:STE 126
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-3329
Practice Address - Country:US
Practice Address - Phone:210-494-2820
Practice Address - Fax:210-494-2002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-28
Last Update Date:2015-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty