Healthcare Provider Details

I. General information

NPI: 1770113433
Provider Name (Legal Business Name): TIERRA PULLARD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/22/2020
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13223 BLACK MOUNTAIN RD # 1508
SAN DIEGO CA
92129-2698
US

IV. Provider business mailing address

13223 BLACK MOUNTAIN RD # 1508
SAN DIEGO CA
92129-2698
US

V. Phone/Fax

Practice location:
  • Phone: 858-753-5082
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number26440
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: