Provider Demographics
NPI:1235297839
Name:GURULE, MANUEL A (MD)
Entity Type:Individual
Prefix:DR
First Name:MANUEL
Middle Name:A
Last Name:GURULE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3874 MASTHEAD ST NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-4479
Mailing Address - Country:US
Mailing Address - Phone:505-944-7555
Mailing Address - Fax:505-944-7552
Practice Address - Street 1:3874 MASTHEAD ST NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-4479
Practice Address - Country:US
Practice Address - Phone:505-944-7555
Practice Address - Fax:505-944-7552
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2023-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2001-2022084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMF1734Medicaid
NMS25394298RMedicare ID - Type Unspecified
NMF1734Medicaid