Provider Demographics
NPI:1104118058
Name:PULIDO, CARMEN (PHD)
Entity type:Individual
Prefix:DR
First Name:CARMEN
Middle Name:
Last Name:PULIDO
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15902 HEATHERDALE DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77059-5920
Mailing Address - Country:US
Mailing Address - Phone:858-405-1769
Mailing Address - Fax:
Practice Address - Street 1:723 E HIGHWAY 30
Practice Address - Street 2:
Practice Address - City:GONZALES
Practice Address - State:LA
Practice Address - Zip Code:70737-4715
Practice Address - Country:US
Practice Address - Phone:225-743-2698
Practice Address - Fax:225-743-2028
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-11
Last Update Date:2022-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX37321103G00000X, 103TC0700X
CAPSY 24207103T00000X
LA327121103TC0700X, 103TP0016X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TP0016XBehavioral Health & Social Service ProvidersPsychologistPrescribing (Medical)
No103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical