# GUATEVIDA LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Dermitech Phototherapy
- **Organization subpart:** No

## Provider details

- **NPI number:** 1053714915
- **Authorized official:** JOHN RILEY (OWNER)
- **Authorized official phone:** (214) 695-4942

## Contact information

- **Practice address:** 14330 MIDWAY RD STE 229, DALLAS, TX 75244-3514
- **Practice address phone:** (214) 377-8144
- **Practice address fax:** (214) 414-2533
- **Mailing address:** PO BOX 801403, DALLAS, TX 75380-1403
- **Mailing address phone:** (214) 377-8144
- **Mailing address fax:** (214) 414-2533

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332B00000X | Durable Medical Equipment & Medical Supplies | — | NULL | Yes |
| 332BC3200X | Customized Equipment (DME) | — | NULL | — |

## Other

- **Enumeration date:** 10/06/2014
- **Last updated:** 12/05/2024