Healthcare Provider Details

I. General information

NPI: 1962389346
Provider Name (Legal Business Name): GERARDO PULIDO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2025
Last Update Date: 08/19/2025
Certification Date: 08/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2481 W HORIZON RIDGE PKWY
HENDERSON NV
89052-2617
US

IV. Provider business mailing address

5005 CLOUDS REST AVE
LAS VEGAS NV
89108-4079
US

V. Phone/Fax

Practice location:
  • Phone: 775-515-7770
  • Fax:
Mailing address:
  • Phone: 702-427-2455
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberNVMT.13144
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: