MEDICARE: MIRANDA 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	106H00000X	Marriage & Family Therapist	MG61475111	WA
2	171M00000X	Case Manager/Care Coordinator
3	101YP2500X	Professional Counselor	CI5172	NV
4	225400000X	Rehabilitation Practitioner

General Provider Information

NPI Number	:	1467917849
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MIRANDA PULIDO

Provider Business Mailing Address
First Line	:	100 N HOWARD ST STE W
Second Line	:
City	:	SPOKANE
State	:	WA
Zip	:	99201-0508
Country	:	US
Telephone Number	:	509-900-5845
Fax Number	:

Provider Business Practice Location Address
First Line	:	100 N HOWARD ST STE W
Second Line	:
City	:	SPOKANE
State	:	WA
Zip	:	99201-0508
Country	:	US
Telephone Number	:	509-903-0103
Fax Number	:

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

Provider Enumeration Date	:	02/09/2019
Last Update Date	:	04/10/2026

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Directions to “ MIRANDA PULIDO ” Practice Location

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