Provider Demographics
NPI:1639437494
Name:PULIDO, JESICA (MD)
Entity Type:Individual
Prefix:
First Name:JESICA
Middle Name:
Last Name:PULIDO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JESICA
Other - Middle Name:
Other - Last Name:BOGARIN MARTINEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:11234 ANDERSON ST
Mailing Address - Street 2:GME OFFICE CSP 21005
Mailing Address - City:LOMA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92354-2804
Mailing Address - Country:US
Mailing Address - Phone:909-651-5809
Mailing Address - Fax:909-558-4087
Practice Address - Street 1:11234 ANDERSON ST
Practice Address - Street 2:GME OFFICE CSP 21005
Practice Address - City:LOMA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92354-2804
Practice Address - Country:US
Practice Address - Phone:909-651-5809
Practice Address - Fax:909-558-4087
Is Sole Proprietor?:No
Enumeration Date:2012-04-30
Last Update Date:2012-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program