Healthcare Provider Details

I. General information

NPI: 1215700943
Provider Name (Legal Business Name): BELLA VIDA TMS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2023
Last Update Date: 09/28/2024
Certification Date: 09/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9250 W THOMAS RD STE 100
PHOENIX AZ
85037-3383
US

IV. Provider business mailing address

9250 W THOMAS RD STE 100
PHOENIX AZ
85037-3383
US

V. Phone/Fax

Practice location:
  • Phone: 602-465-9917
  • Fax: 602-835-0559
Mailing address:
  • Phone: 602-610-1191
  • Fax: 602-835-0559

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: MS. BRITTANY CAVICCHIONI
Title or Position: CEO
Credential:
Phone: 602-610-1191