Provider Demographics
NPI:1568604833
Name:PULIDO, DENISE MARIE (LICENSED INDEPENDENT)
Entity Type:Individual
Prefix:MS
First Name:DENISE
Middle Name:MARIE
Last Name:PULIDO
Suffix:
Gender:F
Credentials:LICENSED INDEPENDENT
Other - Prefix:MS
Other - First Name:DENISE
Other - Middle Name:MARIE
Other - Last Name:SAMBRANO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LICENSE INDEPENDENT
Mailing Address - Street 1:400 S SYCAMORE AVE
Mailing Address - Street 2:SUITE 105-3
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57110-1246
Mailing Address - Country:US
Mailing Address - Phone:605-334-3739
Mailing Address - Fax:605-334-7752
Practice Address - Street 1:400 S SYCAMORE AVE
Practice Address - Street 2:SUITE 105-3
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57110-1246
Practice Address - Country:US
Practice Address - Phone:605-334-3739
Practice Address - Fax:605-334-7752
Is Sole Proprietor?:No
Enumeration Date:2009-04-01
Last Update Date:2014-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD32241041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD2006644Medicaid
SDS107619Medicare PIN