Organization
GUIDA, LLC
Active
Other names
Phoenix Behavioral Health
Organization subpart
No
Provider details
NPI number
Authorized official
TARA GUIDA PA-C (OWNER)
(757) 933-3130
Entity
Organization
Contact information
Practice address
505 S INDEPENDENCE BLVD STE 207, VIRGINIA BEACH, VA 23452-1150
(757) 933-3130
(757) 401-6206
Mailing address
2245 TANGLEWOOD TRL, VIRGINIA BEACH, VA 23454-2128
(757) 761-6137
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1790799005
—
VA
Enumeration date
09/17/2020
Last updated
09/17/2020
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