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 1:2250 4TH AVE
Mailing Address - Street 2:SUITE 301
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92101-2124
Mailing Address - Country:US
Mailing Address - Phone:619-525-9903
Mailing Address - Fax:619-525-9908
Practice Address - Street 1:2250 4TH AVE
Practice Address - Street 2:SUITE 301
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92101-2124
Practice Address - Country:US
Practice Address - Phone:619-525-9903
Practice Address - Fax:619-525-9908
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-10
Last Update Date:2012-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist