Provider Demographics
NPI:1013636828
Name:GURROLA, GUADALUPE AMANDA
Entity type:Individual
Prefix:
First Name:GUADALUPE
Middle Name:AMANDA
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 1:1180 W MAHALO PL UNIT B
Mailing Address - Street 2:
Mailing Address - City:COMPTON
Mailing Address - State:CA
Mailing Address - Zip Code:90220-5443
Mailing Address - Country:US
Mailing Address - Phone:310-868-5379
Mailing Address - Fax:
Practice Address - Street 1:1180 W MAHALO PL UNIT B
Practice Address - Street 2:
Practice Address - City:COMPTON
Practice Address - State:CA
Practice Address - Zip Code:90220-5443
Practice Address - Country:US
Practice Address - Phone:310-868-5379
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-24
Last Update Date:2024-06-24
Deactivation Date:2023-09-22
Deactivation Code:
Reactivation Date:2023-10-02
Provider Licenses
StateLicense IDTaxonomies
CAACSW117544104100000X
CA117544104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker