Provider Demographics
NPI:1972191302
Name:GURROLA, ELIZABETH JUAREZ
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:JUAREZ
Last Name:GURROLA
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 1:511 DENNERY RD APT 157
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92154-8571
Mailing Address - Country:US
Mailing Address - Phone:619-852-1405
Mailing Address - Fax:
Practice Address - Street 1:1100 INDUSTRIAL BLVD SPC C29
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91911-2679
Practice Address - Country:US
Practice Address - Phone:619-518-3212
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-31
Last Update Date:2021-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAD7564004OtherDRIVER LICENSE