Mira Vita Metamophosis, LLC

NPI #1073910873 in Glendale, Arizona

Provider Information

NPI Number: 1073910873
Entity Type: Organization
Organization Name: Mira Vita Metamophosis, LLC
Primary Specialty: Internal Medicine
Enumeration Date: Nov 24, 2014
Last Updated: Jan 30, 2020

Practice Location

Address: 5620 W THUNDERBIRD RD STE H2
City: Glendale
State: Arizona
ZIP Code: 85306-4653
Phone: (480) 407-9007

Authorized Official

Name: ANGELA MARIE DEROSA, DO
Title: OWNER
Phone: (480) 619-4097

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Internal Medicine	207R00000X	Primary

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