Healthcare Provider Details

I. General information

NPI: 1326853946
Provider Name (Legal Business Name): MISS THALIA CAJINA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/11/2025
Last Update Date: 02/11/2025
Certification Date: 02/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11400 JOG ROAD SUITE 105
PALM BEACH GARDENS FL
33418-1756
US

IV. Provider business mailing address

11400 N JOG ROAD SUITE 105
PALM BEACH GARDENS FL
33418-1756
US

V. Phone/Fax

Practice location:
  • Phone: 561-486-8146
  • Fax:
Mailing address:
  • Phone: 561-486-8146
  • Fax: 561-689-3639

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberAST1401
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: