Provider Demographics
NPI:1811503535
Name:GUIDA, LLC
Entity type:Organization
Organization Name:GUIDA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TARA
Authorized Official - Middle Name:
Authorized Official - Last Name:GUIDA
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:757-933-3130
Mailing Address - Street 1:2245 TANGLEWOOD TRL
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23454-2128
Mailing Address - Country:US
Mailing Address - Phone:757-761-6137
Mailing Address - Fax:
Practice Address - Street 1:505 S INDEPENDENCE BLVD STE 207
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23452-1150
Practice Address - Country:US
Practice Address - Phone:757-933-3130
Practice Address - Fax:757-401-6206
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-17
Last Update Date:2020-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1790799005Medicaid