Provider Demographics
NPI:1225925571
Name:FERNANDEZ ESCALONA, THALIA DE LAS MERCEDES
Entity type:Individual
Prefix:
First Name:THALIA
Middle Name:DE LAS MERCEDES
Last Name:FERNANDEZ ESCALONA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:N/A
Other - Middle Name:
Other - Last Name:N/A
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1242 NW 20TH PL
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33993-5930
Mailing Address - Country:US
Mailing Address - Phone:239-327-4922
Mailing Address - Fax:
Practice Address - Street 1:1242 NW 20TH PL
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33993-5930
Practice Address - Country:US
Practice Address - Phone:239-327-4922
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-19
Last Update Date:2025-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty