Provider Demographics
NPI:1467238071
Name:PULIDO, LUIS ALFONSO
Entity Type:Individual
Prefix:
First Name:LUIS
Middle Name:ALFONSO
Last Name:PULIDO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14819 DOWNEY AVE APT 310
Mailing Address - Street 2:
Mailing Address - City:PARAMOUNT
Mailing Address - State:CA
Mailing Address - Zip Code:90723-5803
Mailing Address - Country:US
Mailing Address - Phone:310-756-5463
Mailing Address - Fax:
Practice Address - Street 1:14819 DOWNEY AVE APT 310
Practice Address - Street 2:
Practice Address - City:PARAMOUNT
Practice Address - State:CA
Practice Address - Zip Code:90723-5803
Practice Address - Country:US
Practice Address - Phone:310-756-5463
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-08
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst