Basic Information
| Provider Information | |||||||||
| NPI: | 1790404689 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GURROLA | ||||||||
| FirstName: | MAIRA | ||||||||
| MiddleName: | MARIE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3780 ROSIN CT STE 110 | ||||||||
| Address2: | |||||||||
| City: | SACRAMENTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 958341698 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9164410226 | ||||||||
| FaxNumber: | 9164416377 | ||||||||
| Practice Location | |||||||||
| Address1: | 630 BERCUT DR STE C | ||||||||
| Address2: | |||||||||
| City: | SACRAMENTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 958110110 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9164413819 | ||||||||
| FaxNumber: | 9164416377 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/24/2022 | ||||||||
| LastUpdateDate: | 08/24/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/24/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | Y | Behavioral Health & Social Service Providers | Counselor |
No ID Information.