Provider Demographics
NPI:1174189427
Name:MORA PULIDO, BRENDA
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:
Last Name:MORA PULIDO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6345 SEVILLE AVE FRNT
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90255-4228
Mailing Address - Country:US
Mailing Address - Phone:323-392-6516
Mailing Address - Fax:
Practice Address - Street 1:9829 CARMENITA RD STE H
Practice Address - Street 2:
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90605-3262
Practice Address - Country:US
Practice Address - Phone:562-907-7429
Practice Address - Fax:562-696-8640
Is Sole Proprietor?:No
Enumeration Date:2019-05-13
Last Update Date:2019-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator