Maira Marie Gurrola
Individual provider Active NPI Marriage & Family Therapist · Esparto, CA
NPI 1790404689 · NPPES record last updated Jan 29, 2024
Key facts
- NPI
- 1790404689
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Marriage & Family Therapist 106H00000X
- License
- 143965 (CA)
- Practice address
- 17317 Fremont St
Esparto, CA 95627-2137 - Phone
- (530) 787-4110
- NPI assigned
- Aug 24, 2022
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 143965 | CA | MD | Marriage & Family Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Rural Innovations in Social Economics, Incorporated | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Marriage & Family Therapist | 106H00000X | 143965 | CA | Yes |
Addresses
Primary practice location
17317 Fremont St
Esparto, CA 95627-2137
Mailing address
17317 Fremont St
Esparto, CA 95627-2137
Phone (530) 787-4110
Other providers in Esparto, CA
- Communicare Health Centers
- Community Medical Centers, Inc.
- Amanda Marie De la Cruz
- Kathleen Diezel
- Esparto Unified School District
- Daniela Hernandez
- Aubrey Hope Bunch Lemire
- Ana Chabeli Lopez
- Lorena Lopez
- Idalia Mendoza
All providers in Esparto, CA · Marriage & Family Therapist in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 29, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.