Healthcare Provider Details

I. General information

NPI: 1942024427
Provider Name (Legal Business Name): LAURA GROTA NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/12/2024
Last Update Date: 11/12/2024
Certification Date: 11/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2277 NW MILITARY HWY
SAN ANTONIO TX
78213-1853
US

IV. Provider business mailing address

615 IMLAY ST
SAN ANTONIO TX
78209-4557
US

V. Phone/Fax

Practice location:
  • Phone: 210-796-8602
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1179050
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: