Mary Angela Pulido-Banner

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

PY0951 Issued in NV

Practice address

1462 US Highway 395 N
Gardnerville, NV 89410-5203

Phone

(775) 553-0668

Fax

(775) 319-5922

NPI assigned

May 21, 2009

Last updated

Jan 19, 2024By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Equanimity Counseling and Psychological Services

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Gardnerville, NV
  • NPI 1124878285

  Clinical

  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1242864000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1705622400000",
    "number": "1790910669",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6700 N LINDER RD STE 156A",
            "address_2": "#331",
            "city": "MERIDIAN",
            "state": "ID",
            "postal_code": "836466606",
            "telephone_number": "775-781-3122",
            "fax_number": "775-319-5922"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1462 US HIGHWAY 395 N",
            "city": "GARDNERVILLE",
            "state": "NV",
            "postal_code": "894105203",
            "telephone_number": "775-553-0668",
            "fax_number": "775-319-5922"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PULIDO-BANNER",
        "first_name": "MARY",
        "middle_name": "ANGELA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-05-21",
        "last_updated": "2024-01-19",
        "certification_date": "2024-01-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "NV",
            "license": "PY0951",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Powerback Rehabilitation LLC (Powerback Rehabilitation)
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• Kyle Gregory Psilopoulos, PHARMD
• Lisa Victoria Pualuan
• Qsmedico Inc
• Raleys
• Ralph D. Herbig, DO, LTD (Herbig Family Medicine)
• Paul Ramirez, M.D.
• Frank L Raschilla, DDS

• Clinical Psychologist in Gardnerville, NV
• Providers in Gardnerville, NV by specialty
• Clinical Psychologist in Nevada

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 19, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.