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NPI Code Detail

MEDICARE: TRISTIAN BEA THAO

MEDICARE: TRISTIAN BEA THAO
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1386597920
Entity Type Code : Individual
Provider Name (Legal Business Name) : TRISTIAN BEA THAO
Provider Business Mailing Address
First Line : 996 ROYAL MARCO WAY
Second Line :
City : MARCO ISLAND
State : FL
Zip : 34145-1829
Country : US
Telephone Number : 469-694-1754
Fax Number :
Provider Business Practice Location Address
First Line : 5168 N BLYTHE AVE STE 102
Second Line :
City : FRESNO
State : CA
Zip : 93722-6478
Country : US
Telephone Number : 559-255-5900
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/16/2026
Last Update Date : 03/16/2026

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Directions to “ TRISTIAN BEA THAO ” Practice Location

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