Provider Demographics
NPI:1417222977
Name:GRUBER, LAURA M (IBCLC)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:M
Last Name:GRUBER
Suffix:
Gender:F
Credentials:IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 16167
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78212
Mailing Address - Country:US
Mailing Address - Phone:210-646-1570
Mailing Address - Fax:281-925-0648
Practice Address - Street 1:15303 HUEBNER RD STE 15
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78248-0983
Practice Address - Country:US
Practice Address - Phone:210-646-1570
Practice Address - Fax:281-925-0648
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-16
Last Update Date:2017-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL-14281174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN