Mira Vita Metamophosis, Llc | |
5620 W Thunderbird Rd Ste H2 Glendale AZ 85306-4653 | |
(480) 407-9007 | |
(833) 817-6790 |
Full Name | Mira Vita Metamophosis, Llc |
---|---|
Speciality | Internal Medicine |
Location | 5620 W Thunderbird Rd Ste H2, Glendale, Arizona |
Authorized Official Name and Position | Angela Marie Derosa (OWNER) |
Authorized Official Contact | 4806194097 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
---|---|
Mira Vita Metamophosis, Llc 5620 W Thunderbird Rd Ste H2 Glendale AZ 85306-4653 Ph: (480) 407-9007 | Mira Vita Metamophosis, Llc 5620 W Thunderbird Rd Ste H2 Glendale AZ 85306-4653 Ph: (480) 407-9007 |
NPI Number | 1073910873 |
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Provider Enumeration Date | 11/24/2014 |
Last Update Date | 01/30/2020 |
Identifier | Type | State | Issuer |
---|---|---|---|
1073910873 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207R00000X | Internal Medicine | 4223 (Arizona) | Primary |
207R00000X | Internal Medicine | (* (Not Available)) | Secondary |
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