Provider Demographics
NPI:1477841625
Name:POLIDO, DAISY (LMFT)
Entity type:Individual
Prefix:
First Name:DAISY
Middle Name:
Last Name:POLIDO
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2249 PAJARO ST
Mailing Address - Street 2:
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93030-0128
Mailing Address - Country:US
Mailing Address - Phone:805-718-0104
Mailing Address - Fax:
Practice Address - Street 1:1765 GOODYEAR AVE STE 206
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-8025
Practice Address - Country:US
Practice Address - Phone:805-718-0104
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-20
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA112342106H00000X
101Y00000X
CA89180106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA174400000XOtherOTHER