MIRA VITA METAMOPHOSIS, LLC

GLENDALE, AZ
NPI1073910873
Entity TypeOrganization
Authorized ContactANGELA MARIE DEROSA
Owner
480-619-4097
Organization Subpart ?No
Primary Taxonomy207R00000X Internal Medicine
(Licence: AZ  4223)
Additional Taxonomies207R00000X Internal Medicine
Enumeration Date2014-11-24
Last Update Date2020-01-30
Business Address
MIRA VITA METAMOPHOSIS, LLC
5620 W THUNDERBIRD RD STE H2
GLENDALE, AZ 85306-4653
Phone number: 480-407-9007
Mailing Address
MIRA VITA METAMOPHOSIS, LLC
5620 W THUNDERBIRD RD STE H2
GLENDALE, AZ 85306-4653
Phone number: 480-407-9007