Provider Demographics
NPI:1104655471
Name:APEZTEGUIA, THALYA
Entity type:Individual
Prefix:
First Name:THALYA
Middle Name:
Last Name:APEZTEGUIA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1529 NW 67TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33147-7125
Mailing Address - Country:US
Mailing Address - Phone:786-624-0157
Mailing Address - Fax:
Practice Address - Street 1:1529 NW 67TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33147-7125
Practice Address - Country:US
Practice Address - Phone:786-624-0157
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-26
Last Update Date:2024-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL24-353744106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician