Provider Demographics
NPI:1356881049
Name:MARURI, RAISA (MSEDSPD)
Entity type:Individual
Prefix:
First Name:RAISA
Middle Name:
Last Name:MARURI
Suffix:
Gender:F
Credentials:MSEDSPD
Other - Prefix:
Other - First Name:RAISA
Other - Middle Name:
Other - Last Name:GUERRERO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSEDSPED
Mailing Address - Street 1:120 W 176TH ST
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10453-6713
Mailing Address - Country:US
Mailing Address - Phone:000-000-0000
Mailing Address - Fax:
Practice Address - Street 1:120 W 176TH ST
Practice Address - Street 2:3B
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10453-6713
Practice Address - Country:US
Practice Address - Phone:917-645-8314
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-01
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY865097174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY865097OtherNEW YORK STATE EDUCATION DEPARTMENT