Provider Demographics
NPI:1003704818
Name:THOMAS, THALIA
Entity type:Individual
Prefix:
First Name:THALIA
Middle Name:
Last Name:THOMAS
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 1:1135 BIRD AVENUE
Mailing Address - Street 2:APARTMENT 3
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95125
Mailing Address - Country:US
Mailing Address - Phone:775-516-3164
Mailing Address - Fax:
Practice Address - Street 1:1505 MERIDIAN AVE STE B
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95125-5353
Practice Address - Country:US
Practice Address - Phone:628-587-7297
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-27
Last Update Date:2025-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician