Provider Demographics
NPI:1811457856
Name:PULIYANDA, KOREY VISHWANATH (BCBA)
Entity type:Individual
Prefix:
First Name:KOREY
Middle Name:VISHWANATH
Last Name:PULIYANDA
Suffix:
Gender:M
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 RAVEN LN
Mailing Address - Street 2:
Mailing Address - City:ALISO VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92656-1886
Mailing Address - Country:US
Mailing Address - Phone:949-278-3002
Mailing Address - Fax:
Practice Address - Street 1:510 WHISPERING WIND DR STE 110
Practice Address - Street 2:
Practice Address - City:TRACY
Practice Address - State:CA
Practice Address - Zip Code:95377-8119
Practice Address - Country:US
Practice Address - Phone:209-832-7756
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-25
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-23-65522103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst