Provider Demographics
NPI:1588003669
Name:PULIDO, JOSE ALFONSO
Entity Type:Individual
Prefix:
First Name:JOSE
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 1:34800 BOB WILSON DR
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92134-6200
Mailing Address - Country:US
Mailing Address - Phone:619-532-9081
Mailing Address - Fax:619-532-5180
Practice Address - Street 1:34800 BOB WILSON DR
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92134-5191
Practice Address - Country:US
Practice Address - Phone:619-532-9081
Practice Address - Fax:619-532-5180
Is Sole Proprietor?:No
Enumeration Date:2013-06-21
Last Update Date:2021-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX50162183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist