Healthcare Provider Details

I. General information

NPI: 1083025639
Provider Name (Legal Business Name): LAURA THODE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2014
Last Update Date: 09/01/2023
Certification Date: 09/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31720 TEMECULA PKWY STE 200
TEMECULA CA
92592-5895
US

IV. Provider business mailing address

425 N DATE ST
ESCONDIDO CA
92025-3413
US

V. Phone/Fax

Practice location:
  • Phone: 833-867-4642
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY34436
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: