Mary Gurrola, CADTP

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

6029 Issued in CA

Practice address

1094 S E St
San Bernardino, CA 92415-5230

Phone

(909) 388-1905

Fax

(909) 381-1062

NPI assigned

Feb 7, 2007

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1170806400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1672876800000",
    "number": "1124168455",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1094 S E ST",
            "city": "SAN BERNARDINO",
            "state": "CA",
            "postal_code": "924150084",
            "telephone_number": "909-388-1905"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1094 S E ST",
            "city": "SAN BERNARDINO",
            "state": "CA",
            "postal_code": "924155230",
            "telephone_number": "909-388-1905",
            "fax_number": "909-381-1062"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "850 E Foothill Blvd",
            "address_purpose": "LOCATION",
            "city": "Rialto",
            "state": "CA",
            "postal_code": "923765230",
            "country_code": "US",
            "telephone_number": "909-421-9406",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GURROLA",
        "first_name": "MARY",
        "name_prefix": "Ms.",
        "credential": "CADTP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-02-07",
        "last_updated": "2023-01-05",
        "certification_date": "2023-01-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "CA",
            "license": "G0407170935",
            "primary": false
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "CA",
            "license": "6029",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Gundi Heimir Gunnarsson, P.T.
• Charles Edward Gunnoe Jr., BA
• Radhika Rajendra Gupta, PT
• Meena Suresh Gurbani, MD
• Gurmeet S. Mulatni M.D. Inc.
• Ella Berlyn Gusman, LPCC
• Rebekah Lynn Gusman, RN
• Tanyell Gussman
• Erin Cecilia Gustafson, M.D.
• Rosanna Gustafson

• Addiction (Substance Use Disorder) Counselor in San Bernardino, CA
• Providers in San Bernardino, CA by specialty
• Addiction (Substance Use Disorder) Counselor in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 5, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.