Healthcare Provider Details

I. General information

NPI: 1407770191
Provider Name (Legal Business Name): MARCO AURELIO LABORIN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2026
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12990 PASEO LUCIDO
SAN DIEGO CA
92128-4479
US

IV. Provider business mailing address

12990 PASEO LUCIDO
SAN DIEGO CA
92128-4479
US

V. Phone/Fax

Practice location:
  • Phone: 858-485-4850
  • Fax: 858-485-4865
Mailing address:
  • Phone: 858-485-4850
  • Fax: 858-485-4865

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: