Provider Demographics
NPI:1164092821
Name:THAI, TINA C
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:C
Last Name:THAI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ELIO
Other - Middle Name:C
Other - Last Name:THAI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:6315 BASTILLE CT
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91739-2276
Mailing Address - Country:US
Mailing Address - Phone:909-414-9310
Mailing Address - Fax:
Practice Address - Street 1:4688 ONTARIO MILLS PKWY
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91764-5104
Practice Address - Country:US
Practice Address - Phone:714-834-1111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-25
Last Update Date:2021-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst