Provider Demographics
NPI:1396534061
Name:PULIDO, BLITE KHIRSTEEN LAZARO
Entity type:Individual
Prefix:
First Name:BLITE KHIRSTEEN
Middle Name:LAZARO
Last Name:PULIDO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:491 D ST
Mailing Address - Street 2:
Mailing Address - City:COLMA
Mailing Address - State:CA
Mailing Address - Zip Code:94014-3152
Mailing Address - Country:US
Mailing Address - Phone:816-500-6523
Mailing Address - Fax:
Practice Address - Street 1:491 D ST
Practice Address - Street 2:
Practice Address - City:COLMA
Practice Address - State:CA
Practice Address - Zip Code:94014-3152
Practice Address - Country:US
Practice Address - Phone:816-500-6523
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-01
Last Update Date:2025-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95033224363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care