Provider Demographics
NPI:1710163621
Name:RAJU, LAURA MICHELE
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:MICHELE
Last Name:RAJU
Suffix:
Gender:F
Credentials:
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 140
Mailing Address - Street 2:
Mailing Address - City:POWAY
Mailing Address - State:CA
Mailing Address - Zip Code:92074-0140
Mailing Address - Country:US
Mailing Address - Phone:619-335-8336
Mailing Address - Fax:877-992-7405
Practice Address - Street 1:9820 WILLOW CREEK RD STE 245
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92131-1116
Practice Address - Country:US
Practice Address - Phone:619-335-8336
Practice Address - Fax:877-992-7405
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-10
Last Update Date:2025-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA81853106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist