MEDICARE: LAURA MICHELE RAJU

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	81853	CA

General Provider Information

NPI Number	:	1710163621
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA MICHELE RAJU

Provider Business Mailing Address
First Line	:	PO BOX 140
Second Line	:
City	:	POWAY
State	:	CA
Zip	:	92074-0140
Country	:	US
Telephone Number	:	619-335-8336
Fax Number	:	877-992-7405

Provider Business Practice Location Address
First Line	:	9820 WILLOW CREEK RD STE 245
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92131-1116
Country	:	US
Telephone Number	:	619-335-8336
Fax Number	:	877-992-7405

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/10/2008
Last Update Date	:	03/03/2025

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