Provider Demographics
NPI:1992363394
Name:SERNA PUJOL, THALIA
Entity Type:Individual
Prefix:
First Name:THALIA
Middle Name:
Last Name:SERNA PUJOL
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 1:1160 S SEMORAN BLVD
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32807-1461
Mailing Address - Country:US
Mailing Address - Phone:800-676-5130
Mailing Address - Fax:888-959-5753
Practice Address - Street 1:1160 S SEMORAN BLVD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32807-1461
Practice Address - Country:US
Practice Address - Phone:800-676-5130
Practice Address - Fax:888-959-5753
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-31
Last Update Date:2020-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician