Healthcare Provider Details

I. General information

NPI: 1265287734
Provider Name (Legal Business Name): THALIA CHAVELY ESQUIVEL PEREZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/18/2024
Last Update Date: 04/18/2024
Certification Date: 04/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

919 SARAZEN DR
WEST PALM BEACH FL
33413-1234
US

IV. Provider business mailing address

919 SARAZEN DR
WEST PALM BEACH FL
33413-1234
US

V. Phone/Fax

Practice location:
  • Phone: 561-323-5083
  • Fax:
Mailing address:
  • Phone: 561-323-5083
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: