MEDICARE: LAURA PORTNER PHD

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	103TC1900X	Counseling Psychologist	34637	CA

General Provider Information

NPI Number	:	1750992400
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA PORTNER PHD

Provider Business Mailing Address
First Line	:	2105 PASEO DORADO
Second Line	:
City	:	LA JOLLA
State	:	CA
Zip	:	92037-3234
Country	:	US
Telephone Number	:	858-766-8069
Fax Number	:

Provider Business Practice Location Address
First Line	:	2105 PASEO DORADO
Second Line	:
City	:	LA JOLLA
State	:	CA
Zip	:	92037-3234
Country	:	US
Telephone Number	:	858-766-8069
Fax Number	:

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

Provider Enumeration Date	:	08/14/2020
Last Update Date	:	01/09/2026

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Directions to “ LAURA PORTNER PHD” Practice Location

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