Provider Demographics
NPI:1710675004
Name:THOMAS, JULIANO JOZIAH
Entity Type:Individual
Prefix:
First Name:JULIANO
Middle Name:JOZIAH
Last Name:THOMAS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11205 SARAHJOE BRIGHT PL
Mailing Address - Street 2:
Mailing Address - City:SEFFNER
Mailing Address - State:FL
Mailing Address - Zip Code:33584-3236
Mailing Address - Country:US
Mailing Address - Phone:813-970-3064
Mailing Address - Fax:
Practice Address - Street 1:9225 BAY PLAZA BLVD STE 401
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33619-4412
Practice Address - Country:US
Practice Address - Phone:813-440-4933
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-25
Last Update Date:2023-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-23-261840106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician