Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | 04322 | MD |
Y | 103T00000X | Psychologist | 04322 | MD |
N | 103TA0700X | Adult Development & Aging Psychologist | 04322 | MD |
N | 103TB0200X | Cognitive & Behavioral Psychologist | 04322 | MD |
N | 103G00000X | Clinical Psychologist | 04322 | MD |
N | 103TC0700X | Clinical Psychologist | 04322 | MD |
NPI | 1013120781 |
---|---|
Provider Name | Ruben Dario Pulido |
First Address | Omaha, NE 68105-1850 |
Second Address | Omaha, NE 68105-1850 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/05/2007 |
Last Update Date | 15/10/2010 |