Provider Demographics
NPI:1942337753
Name:PULIDO, MAYRA ALEJANDRA (OTR)
Entity type:Individual
Prefix:
First Name:MAYRA
Middle Name:ALEJANDRA
Last Name:PULIDO
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1412 ELM DR
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78572-4513
Mailing Address - Country:US
Mailing Address - Phone:956-581-7171
Mailing Address - Fax:956-581-7178
Practice Address - Street 1:7600 W EXPRESSWAY 83
Practice Address - Street 2:
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78572-9561
Practice Address - Country:US
Practice Address - Phone:956-581-7171
Practice Address - Fax:956-581-7178
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX110763225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8T6210OtherBCBS WITH THERA-CARE
TX8T6210OtherBCBS WITH THERA-CARE