Healthcare Provider Details

I. General information

NPI: 1831936616
Provider Name (Legal Business Name): PAULA ANDREA JURADO GAMBOA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2024
Last Update Date: 07/10/2024
Certification Date: 07/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4404 QUEENS BLVD FL 2
SUNNYSIDE NY
11104-2406
US

IV. Provider business mailing address

3721 80TH ST APT 4C
JACKSON HEIGHTS NY
11372-6820
US

V. Phone/Fax

Practice location:
  • Phone: 718-706-1663
  • Fax:
Mailing address:
  • Phone: 917-856-4776
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number122240-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: