Healthcare Provider Details

I. General information

NPI: 1942277967
Provider Name (Legal Business Name): GURUSAMY INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2006
Last Update Date: 11/03/2023
Certification Date: 11/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

655 HARMON LOOP RD STE 102
DEDEDO GU
96929-6544
US

IV. Provider business mailing address

PO BOX 8838
TAMUNING GU
96931-8838
US

V. Phone/Fax

Practice location:
  • Phone: 671-647-5355
  • Fax: 671-989-8836
Mailing address:
  • Phone: 671-647-5355
  • Fax: 671-647-5358

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number13-200400954-010
License Number StateGU

VIII. Authorized Official

Name: MS. RUTH GURUSAMY
Title or Position: PRESIDENT
Credential: RN, MN
Phone: 671-647-5355