Provider Demographics
NPI:1699903153
Name:PULIDO, STEPHEN GLEN
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:GLEN
Last Name:PULIDO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 16TH AVE STE 400
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98122
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:550 16TH AVE
Practice Address - Street 2:SUITE 400
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98122-5699
Practice Address - Country:US
Practice Address - Phone:206-320-2233
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-23
Last Update Date:2020-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAML60097301207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine