Healthcare Provider Details

I. General information

NPI: 1942002225
Provider Name (Legal Business Name): LAURA BROWNE GROGAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LO GROGAN MD

II. Dates (important events)

Enumeration Date: 03/26/2025
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 W ARBOR DR MC # 8218
SAN DIEGO CA
92103-1911
US

IV. Provider business mailing address

200 W ARBOR DR
SAN DIEGO CA
92103-9000
US

V. Phone/Fax

Practice location:
  • Phone: 619-543-5221
  • Fax:
Mailing address:
  • Phone: 619-543-5221
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA210666
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: