Organization
GUATEVIDA LLC
Active
Other names
Dermitech Phototherapy
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN RILEY (OWNER)
(214) 695-4942
Entity
Organization
Contact information
Practice address
14330 MIDWAY RD STE 229, DALLAS, TX 75244-3514
(214) 377-8144
(214) 414-2533
Mailing address
PO BOX 801403, DALLAS, TX 75380-1403
(214) 377-8144
(214) 414-2533
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
332BC3200X
Customized Equipment (DME)
—
—
Other
Enumeration date
10/06/2014
Last updated
12/05/2024
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