Healthcare Provider Details

I. General information

NPI: 1023361755
Provider Name (Legal Business Name): NADIA POLYNICE MFTI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/18/2012
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25743 BARNETT LN
STEVENSON RANCH CA
91381-1125
US

IV. Provider business mailing address

25743 BARNETT LN
STEVENSON RANCH CA
91381-1125
US

V. Phone/Fax

Practice location:
  • Phone: 661-212-4280
  • Fax:
Mailing address:
  • Phone: 661-212-4280
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberIMF 64699
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: