Healthcare Provider Details

I. General information

NPI: 1750992400
Provider Name (Legal Business Name): LAURA PORTNER PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2020
Last Update Date: 01/09/2026
Certification Date: 01/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2105 PASEO DORADO
LA JOLLA CA
92037-3234
US

IV. Provider business mailing address

2105 PASEO DORADO
LA JOLLA CA
92037-3234
US

V. Phone/Fax

Practice location:
  • Phone: 858-766-8069
  • Fax:
Mailing address:
  • Phone: 858-766-8069
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number34637
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: