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General NPI Number Information
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NPI Number | 1811503535
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Entity Type | Organization
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Legal Business Name | GUIDA, LLC
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Dates
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Enumeration Date | 09/17/2020
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Last Update Date | 09/17/2020
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Provider Practice Location Address
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Address Line | 505 S INDEPENDENCE BLVD STE 207
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City | VIRGINIA BEACH
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State | VA
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Zip | 23452-1150
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Country | US
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Telephone | 757-933-3130
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Fax | 757-401-6206
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Provider Business Mailing Address
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Address Line | 2245 TANGLEWOOD TRL
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City | VIRGINIA BEACH
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State | VA
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Zip | 23454-2128
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Country | US
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Telephone | 757-761-6137
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | TARA GUIDA
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Credential | PA-C
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Telephone | 757-933-3130
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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