Healthcare Provider Details

I. General information

NPI: 1295624450
Provider Name (Legal Business Name): THALIA NIEVES-CINTRON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2025
Last Update Date: 07/01/2025
Certification Date: 07/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11240 FM 1960 RD W STE 209
HOUSTON TX
77065-3664
US

IV. Provider business mailing address

430 LAUREL PINE DR
KINGWOOD TX
77339-2563
US

V. Phone/Fax

Practice location:
  • Phone: 954-947-3062
  • Fax: 954-947-3062
Mailing address:
  • Phone: 832-609-4970
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: