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General NPI Number Information
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NPI Number | 1215700943
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Entity Type | Organization
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Legal Business Name | BELLA VIDA TMS LLC
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Dates
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Enumeration Date | 11/03/2023
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Last Update Date | 09/28/2024
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Provider Practice Location Address
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Address Line | 9250 W THOMAS RD STE 100
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City | PHOENIX
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State | AZ
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Zip | 85037-3383
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Country | US
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Telephone | 602-465-9917
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Fax | 602-835-0559
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Provider Business Mailing Address
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Address Line | 9250 W THOMAS RD STE 100
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City | PHOENIX
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State | AZ
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Zip | 85037-3383
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Country | US
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Telephone | 602-610-1191
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Fax | 602-835-0559
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Authorized Official
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Title or Position | CEO
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Name | MS. BRITTANY CAVICCHIONI
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Credential |
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Telephone | 602-610-1191
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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