Provider Demographics
NPI:1023309101
Name:PULIDO, BRANDI NICOLE
Entity type:Individual
Prefix:MRS
First Name:BRANDI
Middle Name:NICOLE
Last Name:PULIDO
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:BRANDI
Other - Middle Name:NICOLE
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 293
Mailing Address - Street 2:
Mailing Address - City:ORANGEVALE
Mailing Address - State:CA
Mailing Address - Zip Code:95662-0293
Mailing Address - Country:US
Mailing Address - Phone:916-409-6881
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 293
Practice Address - Street 2:
Practice Address - City:ORANGEVALE
Practice Address - State:CA
Practice Address - Zip Code:95662-0293
Practice Address - Country:US
Practice Address - Phone:916-409-6881
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-25
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
CA114570106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)