Provider Demographics
NPI:1033249842
Name:PULIDO, MONICA VICTORIA (MSW)
Entity Type:Individual
Prefix:MS
First Name:MONICA
Middle Name:VICTORIA
Last Name:PULIDO
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:263 MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:COLTON
Mailing Address - State:CA
Mailing Address - Zip Code:92324-3518
Mailing Address - Country:US
Mailing Address - Phone:951-203-8742
Mailing Address - Fax:
Practice Address - Street 1:8485 TAMARIND AVE
Practice Address - Street 2:
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92335-3975
Practice Address - Country:US
Practice Address - Phone:909-428-2366
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW 162941041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical