Provider Demographics
NPI:1942633847
Name:PULEO, PHILLIP MARK
Entity Type:Individual
Prefix:
First Name:PHILLIP
Middle Name:MARK
Last Name:PULEO
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 1:2535 N 15TH ST
Mailing Address - Street 2:UNIT 7
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85006-1153
Mailing Address - Country:US
Mailing Address - Phone:480-280-0079
Mailing Address - Fax:
Practice Address - Street 1:2535 N 15TH ST
Practice Address - Street 2:UNIT 7
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85006-1153
Practice Address - Country:US
Practice Address - Phone:480-280-0079
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-14
Last Update Date:2013-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLP043998164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse