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General NPI Number Information
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NPI Number | 1396626529
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Entity Type | Individual
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Provider Name | THALIA DE LA OSA GOMEZ
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Gender | Female
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Dates
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Enumeration Date | 09/12/2025
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Last Update Date | 09/12/2025
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Provider Practice Location Address
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Address Line | 9020 SW 137TH AVE # 111
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City | MIAMI
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State | FL
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Zip | 33186-1427
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Country | US
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Telephone | 786-615-9400
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Fax |
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Provider Business Mailing Address
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Address Line | 3730 METRO PKWY APT 1237
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City | FORT MYERS
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State | FL
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Zip | 33916-7480
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Country | US
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Telephone | 786-442-9952
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number | 24-332635
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License Number State | FL
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