Healthcare Provider Details

I. General information

NPI: 1194391862
Provider Name (Legal Business Name): SANJEEV GURUNG
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2021
Last Update Date: 04/05/2024
Certification Date: 04/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

LANDSTUHL REGIONAL MEDICAL CENTER
LANDSTUHL RP
66849
DE

IV. Provider business mailing address

PSC 10 BOX 432
APO AE
09142-0005
US

V. Phone/Fax

Practice location:
  • Phone: 63-719-4645
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number105494
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: