| Doctor Name: | MS. MARY GURROLA |
| NPI Number: | 1124168455 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | RAS |
| License Number: | G0407170935 |
| Business Practice Address: | 850 E Foothill Blvd Rialto, CA - 923765230 |
| Business Phone Number: | 9094219406 |
| Business Fax Number: | |
| Mailing Address: | 128 Carousel Mall Ste G, SAN BERNARDINO |
| State: | CA |
| Postal Code: | 924150084 |
| Phone Number: | 9093881905 |
| Fax Number: | |
| NPI Enumeration Date: | 02/07/2007 |
| NPI Last Update Date: | 04/27/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | G0407170935 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |