Healthcare Provider Details

I. General information

NPI: 1568604833
Provider Name (Legal Business Name): DENISE MARIE PULIDO LICENSED INDEPENDENT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DENISE MARIE SAMBRANO LICENSE INDEPENDENT

II. Dates (important events)

Enumeration Date: 04/01/2009
Last Update Date: 07/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 S SYCAMORE AVE SUITE 105-3
SIOUX FALLS SD
57110-1246
US

IV. Provider business mailing address

400 S SYCAMORE AVE SUITE 105-3
SIOUX FALLS SD
57110-1246
US

V. Phone/Fax

Practice location:
  • Phone: 605-334-3739
  • Fax: 605-334-7752
Mailing address:
  • Phone: 605-334-3739
  • Fax: 605-334-7752

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number3224
License Number StateSD

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier2006644
Identifier TypeMEDICAID
Identifier StateSD
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: