Healthcare Provider Details

I. General information

NPI: 1821921214
Provider Name (Legal Business Name): LAURA VIRAMONTES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2026
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1819 SMYTHE AVE SPC 70
SAN YSIDRO CA
92173-1548
US

IV. Provider business mailing address

1819 SMYTHE AVE SPC 70
SAN YSIDRO CA
92173-1548
US

V. Phone/Fax

Practice location:
  • Phone: 619-246-2997
  • Fax:
Mailing address:
  • Phone: 619-246-2997
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number15372
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: