Healthcare Provider Details

I. General information

NPI: 1598426678
Provider Name (Legal Business Name): HA THANH THOMAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HA THANH NGUYEN BCBA

II. Dates (important events)

Enumeration Date: 12/31/2021
Last Update Date: 03/11/2024
Certification Date: 03/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4620 N STATE ROAD 7 STE 300
LAUDERDALE LAKES FL
33319-5867
US

IV. Provider business mailing address

3507 PALMILLA DR UNIT 2096
SAN JOSE CA
95134-2265
US

V. Phone/Fax

Practice location:
  • Phone: 561-335-5681
  • Fax:
Mailing address:
  • Phone: 408-908-0737
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-21-57314
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: