Provider Demographics
NPI:1669845004
Name:PULIDO, WILBUR (DBA)
Entity Type:Individual
Prefix:
First Name:WILBUR
Middle Name:
Last Name:PULIDO
Suffix:
Gender:M
Credentials:DBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:291 S MAIN ST
Mailing Address - Street 2:STE L
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85364-1414
Mailing Address - Country:US
Mailing Address - Phone:928-783-0705
Mailing Address - Fax:928-783-4349
Practice Address - Street 1:291 S MAIN ST
Practice Address - Street 2:STE L
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-1414
Practice Address - Country:US
Practice Address - Phone:928-783-0705
Practice Address - Fax:928-783-4349
Is Sole Proprietor?:No
Enumeration Date:2015-11-06
Last Update Date:2015-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA458246163WH1000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH1000XNursing Service ProvidersRegistered NurseHospice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ031627Medicare Oscar/Certification