Provider Demographics
NPI:1457762767
Name:PULIDO, BALTAZAR
Entity Type:Individual
Prefix:
First Name:BALTAZAR
Middle Name:
Last Name:PULIDO
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 1:2459 JUBILEE LN
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95131-1987
Mailing Address - Country:US
Mailing Address - Phone:408-577-7221
Mailing Address - Fax:
Practice Address - Street 1:2459 JUBILEE LN
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95131-1987
Practice Address - Country:US
Practice Address - Phone:408-577-7221
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-08
Last Update Date:2014-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33463167G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes167G00000XNursing Service ProvidersLicensed Psychiatric Technician