Provider Demographics
NPI:1427842004
Name:PULIDO, ARCY JAE
Entity type:Individual
Prefix:
First Name:ARCY
Middle Name:JAE
Last Name:PULIDO
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:239 BENHAM RD APT 20
Mailing Address - Street 2:
Mailing Address - City:GROTON
Mailing Address - State:CT
Mailing Address - Zip Code:06340-5071
Mailing Address - Country:US
Mailing Address - Phone:619-748-9983
Mailing Address - Fax:
Practice Address - Street 1:239 BENHAM RD APT 20
Practice Address - Street 2:
Practice Address - City:GROTON
Practice Address - State:CT
Practice Address - Zip Code:06340-5071
Practice Address - Country:US
Practice Address - Phone:619-748-9983
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-08
Last Update Date:2025-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman