Provider Demographics
NPI:1497251110
Name:LEGROS, THALIA
Entity Type:Individual
Prefix:MS
First Name:THALIA
Middle Name:
Last Name:LEGROS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:THALIA
Other - Middle Name:
Other - Last Name:CHERISME
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:THALIA CHERISME
Mailing Address - Street 1:670 GOODLETTE RD
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34102-5614
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:13195 SW 134TH ST STE 201
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-4585
Practice Address - Country:US
Practice Address - Phone:786-206-6500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-02
Last Update Date:2024-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL016257730OtherTRICARE