Provider Demographics
NPI:1063244259
Name:GURULE, JORDANNA LEIGH
Entity type:Individual
Prefix:
First Name:JORDANNA
Middle Name:LEIGH
Last Name:GURULE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:49 SNAKE SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:CABALLO
Mailing Address - State:NM
Mailing Address - Zip Code:87931-8004
Mailing Address - Country:US
Mailing Address - Phone:575-740-7219
Mailing Address - Fax:
Practice Address - Street 1:312 N BROADWAY ST
Practice Address - Street 2:
Practice Address - City:T OR C
Practice Address - State:NM
Practice Address - Zip Code:87901-2834
Practice Address - Country:US
Practice Address - Phone:575-740-7219
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-15
Last Update Date:2024-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health