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General NPI Number Information
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NPI Number | 1104118058
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Entity Type | Individual
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Provider Name | CARMEN PULIDO PH.D.
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Gender | Female
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Dates
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Enumeration Date | 05/11/2011
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Last Update Date | 09/30/2022
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Provider Practice Location Address
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Address Line | 723 E HIGHWAY 30
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City | GONZALES
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State | LA
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Zip | 70737-4715
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Country | US
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Telephone | 225-743-2698
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Fax | 225-743-2028
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Provider Business Mailing Address
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Address Line | 15902 HEATHERDALE DR
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City | HOUSTON
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State | TX
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Zip | 77059-5920
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Country | US
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Telephone | 858-405-1769
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number | 37321
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PSY 24207
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 327121
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License Number State | LA
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Taxonomy #4
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Taxonomy Code | 103TP0016X
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Taxonomy Name | Prescribing (Medical) Psychologist
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License Number | 327121
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License Number State | LA
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Taxonomy #5
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 37321
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License Number State | TX
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