Provider Demographics
NPI:1346891330
Name:GURROLA, MANUEL ADRIAN
Entity Type:Individual
Prefix:
First Name:MANUEL
Middle Name:ADRIAN
Last Name:GURROLA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4110 COLLEGE MAIN ST APT 73
Mailing Address - Street 2:
Mailing Address - City:BRYAN
Mailing Address - State:TX
Mailing Address - Zip Code:77801-3852
Mailing Address - Country:US
Mailing Address - Phone:915-873-6904
Mailing Address - Fax:
Practice Address - Street 1:4110 COLLEGE MAIN ST APT 73
Practice Address - Street 2:
Practice Address - City:BRYAN
Practice Address - State:TX
Practice Address - Zip Code:77801-3852
Practice Address - Country:US
Practice Address - Phone:915-873-6904
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-22
Last Update Date:2019-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer