Basic Information
| Provider Information | |||||||||
| NPI: | 1295254845 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BREASTFEEDING HOUSECALLS AND LACTATION CLINIC, LLC | ||||||||
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| OtherOrganizationName: | BREASTFEEDING HOUSECALLS LLC | ||||||||
| OtherOrganizationType: | 4 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 16167 | ||||||||
| Address2: | |||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 78212 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2106461570 | ||||||||
| FaxNumber: | 2819250648 | ||||||||
| Practice Location | |||||||||
| Address1: | 15303 HUEBNER RD BLDG 15 | ||||||||
| Address2: | |||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782480983 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2106461570 | ||||||||
| FaxNumber: | 2819250648 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/14/2017 | ||||||||
| LastUpdateDate: | 04/19/2018 | ||||||||
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| AuthorizedOfficialLastName: | GRUBER | ||||||||
| AuthorizedOfficialFirstName: | LAURA | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 2106461570 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | IBCLC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174N00000X | L-14281 | TX | Y | 193200000X MULTI-SPECIALTY GROUP | Other Service Providers | Lactation Consultant, Non-RN |
No ID Information.