Healthcare Provider Details

I. General information

NPI: 1306100300
Provider Name (Legal Business Name): JENILEE PERLAS PULIDO AU.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENILEE MAE PERLAS AU.D

II. Dates (important events)

Enumeration Date: 06/25/2012
Last Update Date: 07/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2800 HILLVIEW ST
SARASOTA FL
34239-3221
US

IV. Provider business mailing address

1878 EAGLE TRACE BLVD
PALM HARBOR FL
34685-3311
US

V. Phone/Fax

Practice location:
  • Phone: 941-316-0406
  • Fax:
Mailing address:
  • Phone: 727-641-0873
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberAY 1733
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: