Provider Demographics
NPI:1427133206
Name:GURULE, ANNA MARIE (DOM)
Entity type:Individual
Prefix:DR
First Name:ANNA
Middle Name:MARIE
Last Name:GURULE
Suffix:
Gender:F
Credentials:DOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1524
Mailing Address - Street 2:
Mailing Address - City:TIJERAS
Mailing Address - State:NM
Mailing Address - Zip Code:87059-1524
Mailing Address - Country:US
Mailing Address - Phone:505-286-8432
Mailing Address - Fax:
Practice Address - Street 1:11792 HWY 337
Practice Address - Street 2:
Practice Address - City:TIJERAS
Practice Address - State:NM
Practice Address - Zip Code:87059-1524
Practice Address - Country:US
Practice Address - Phone:505-286-8432
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM674171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMNM00RH54OtherPROVIDER # FOR BCBSNM