Healthcare Provider Details

I. General information

NPI: 1821928672
Provider Name (Legal Business Name): MARIO PULIDO RODRIGUEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2026
Last Update Date: 05/22/2026
Certification Date: 05/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2585 NORDELL AVE
CASTRO VALLEY CA
94546-4013
US

IV. Provider business mailing address

2050 FAIRMONT DR
CASTRO VALLEY CA
94578-1001
US

V. Phone/Fax

Practice location:
  • Phone: 408-207-3589
  • Fax:
Mailing address:
  • Phone: 408-207-3589
  • Fax: 510-483-3030

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number670584
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: