Healthcare Provider Details

I. General information

NPI: 1992131379
Provider Name (Legal Business Name): VANESSA G PULIDO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2013
Last Update Date: 11/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2101 GEER RD STE 120
TURLOCK CA
95382-2456
US

IV. Provider business mailing address

2101 GEER RD STE 120
TURLOCK CA
95382-2456
US

V. Phone/Fax

Practice location:
  • Phone: 209-525-4974
  • Fax:
Mailing address:
  • Phone: 209-525-4974
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: