Provider Demographics
NPI:1326770017
Name:PULIDO, MARYLU
Entity Type:Individual
Prefix:
First Name:MARYLU
Middle Name:
Last Name: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 1:30100 TOWN CENTER DR # YZ
Mailing Address - Street 2:
Mailing Address - City:LAGUNA NIGUEL
Mailing Address - State:CA
Mailing Address - Zip Code:92677-2064
Mailing Address - Country:US
Mailing Address - Phone:949-276-5401
Mailing Address - Fax:
Practice Address - Street 1:30100 TOWN CENTER DR # YZ
Practice Address - Street 2:
Practice Address - City:LAGUNA NIGUEL
Practice Address - State:CA
Practice Address - Zip Code:92677-2064
Practice Address - Country:US
Practice Address - Phone:949-276-5401
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-30
Last Update Date:2022-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
86005225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist