Basic Information
| Provider Information | |||||||||
| NPI: | 1568604833 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PULIDO | ||||||||
| FirstName: | DENISE | ||||||||
| MiddleName: | MARIE | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LICENSED INDEPENDENT | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | SAMBRANO | ||||||||
| OtherFirstName: | DENISE | ||||||||
| OtherMiddleName: | MARIE | ||||||||
| OtherNamePrefix: | MS. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | LICENSE INDEPENDENT | ||||||||
| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | 400 S SYCAMORE AVE | ||||||||
| Address2: | SUITE 105-3 | ||||||||
| City: | SIOUX FALLS | ||||||||
| State: | SD | ||||||||
| PostalCode: | 571101246 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6053343739 | ||||||||
| FaxNumber: | 6053347752 | ||||||||
| Practice Location | |||||||||
| Address1: | 400 S SYCAMORE AVE | ||||||||
| Address2: | SUITE 105-3 | ||||||||
| City: | SIOUX FALLS | ||||||||
| State: | SD | ||||||||
| PostalCode: | 571101246 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6053343739 | ||||||||
| FaxNumber: | 6053347752 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/01/2009 | ||||||||
| LastUpdateDate: | 07/11/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 3224 | SD | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
ID Information
| ID | Type | State | Issuer | Description | 2006644 | 05 | SD | MEDICAID |