Healthcare Provider Details

I. General information

NPI: 1962047480
Provider Name (Legal Business Name): AMBER DAWN GURULE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/07/2019
Last Update Date: 11/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1850 OLD PECOS TRL STE F
SANTA FE NM
87505-4760
US

IV. Provider business mailing address

1850 OLD PECOS TRL STE F
SANTA FE NM
87505-4760
US

V. Phone/Fax

Practice location:
  • Phone: 505-660-7319
  • Fax:
Mailing address:
  • Phone: 505-660-7319
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number6089
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: