Provider Demographics
NPI:1366138752
Name:POLAINER, DIANA CHRISTINE (MCT)
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:CHRISTINE
Last Name:POLAINER
Suffix:
Gender:F
Credentials:MCT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15700 FOREST VIEW RD
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:CA
Mailing Address - Zip Code:95459-8964
Mailing Address - Country:US
Mailing Address - Phone:916-500-1339
Mailing Address - Fax:
Practice Address - Street 1:15700 FOREST VIEW RD
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:CA
Practice Address - Zip Code:95459-8964
Practice Address - Country:US
Practice Address - Phone:916-500-1339
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-18
Last Update Date:2023-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA71413225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist