MEDICARE: MISS LISBETH PULIDO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2355S0801X	Speech-Language Assistant	35283	TX

General Provider Information

NPI Number	:	1205162419
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS LISBETH PULIDO

Provider Business Mailing Address
First Line	:	15234 HIGHSPRINGS DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77068-1814
Country	:	US
Telephone Number	:	562-719-5492
Fax Number	:

Provider Business Practice Location Address
First Line	:	19411 MCKAY BLVD STE 300
Second Line	:
City	:	HUMBLE
State	:	TX
Zip	:	77338-5713
Country	:	US
Telephone Number	:	281-446-2680
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/22/2009
Last Update Date	:	05/24/2012

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Directions to “ MISS LISBETH PULIDO ” Practice Location

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