Healthcare Provider Details

I. General information

NPI: 1295690972
Provider Name (Legal Business Name): PRISCILLA GUADALUPE NICOLOSI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/16/2025
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21380 CENTRE POINTE PKWY
SANTA CLARITA CA
91350-3050
US

IV. Provider business mailing address

21380 CENTRE POINTE PKWY
SANTA CLARITA CA
91350-3050
US

V. Phone/Fax

Practice location:
  • Phone: 661-259-0033
  • Fax:
Mailing address:
  • Phone: 661-259-0033
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: