Provider Demographics
NPI:1235318080
Name:PULIDO, JESSICA H (ASW)
Entity Type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:H
Last Name:PULIDO
Suffix:
Gender:F
Credentials:ASW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6301 BEACH BLVD
Mailing Address - Street 2:SUITE 245
Mailing Address - City:BUENA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90621-2840
Mailing Address - Country:US
Mailing Address - Phone:714-736-0231
Mailing Address - Fax:714-736-0895
Practice Address - Street 1:6301 BEACH BLVD
Practice Address - Street 2:SUITE 245
Practice Address - City:BUENA PARK
Practice Address - State:CA
Practice Address - Zip Code:90621-2840
Practice Address - Country:US
Practice Address - Phone:714-736-0231
Practice Address - Fax:714-736-0895
Is Sole Proprietor?:No
Enumeration Date:2007-10-29
Last Update Date:2011-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW225221041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical