Provider Demographics
NPI:1912663543
Name:GURUNG, SANTOSH
Entity Type:Individual
Prefix:
First Name:SANTOSH
Middle Name:
Last Name:GURUNG
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 1:747 CHESTNUT AVE APT E102
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:CA
Mailing Address - Zip Code:92223-2365
Mailing Address - Country:US
Mailing Address - Phone:951-396-5921
Mailing Address - Fax:
Practice Address - Street 1:747 CHESTNUT AVE APT E102
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:CA
Practice Address - Zip Code:92223-2365
Practice Address - Country:US
Practice Address - Phone:951-396-5921
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-09
Last Update Date:2021-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor