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General NPI Number Information
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NPI Number | 1336347194
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Entity Type | Individual
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Provider Name | DIANNE B PULIDO ATC
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Gender | Female
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Dates
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Enumeration Date | 07/03/2007
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Last Update Date | 12/05/2007
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Provider Practice Location Address
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Address Line | 565 NUGENTOWN RD
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City | TUCKERTON
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State | NJ
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Zip | 08087-3909
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Country | US
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Telephone | 609-296-3106
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Fax |
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Provider Business Mailing Address
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Address Line | 8 COOPER DR # A
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City | SOMERS POINT
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State | NJ
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Zip | 08244-1608
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Country | US
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Telephone | 609-204-6260
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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 | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 25MT00121300
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License Number State | NJ
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