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Data from the NPPES registry. May not reflect recent changes — verify at nppes.cms.hhs.gov.

MIRA VITA METAMOPHOSIS, LLC

Active Organization

MIRA VITA METAMOPHOSIS, LLC is a Internal Medicine organization located in GLENDALE, Arizona. NPI 1073910873 is currently active in the NPPES registry. Verify at CMS.

Internal Medicine · GLENDALE, AZ

Registration Details

NPI Number
1073910873
Provider Type
Organization
NPI Issued
Nov 24, 2014 (11.733903428044 yrs)
Last Updated
Jan 30, 2020
License
4223 (AZ)

Practice Information

Address
5620 W THUNDERBIRD RD STE H2
GLENDALE, AZ, 853064653
Browse AZ providers · Browse ZIP 85306
Phone
4804079007
Fax
8338176790
Primary Specialty
Internal Medicine
207R00000X
Additional Specialty
Internal Medicine
Data sourced from the NPPES National Provider Identifier registry. Healthcare organizations registered in NPPES are assigned an NPI number for use in insurance billing and claims. This information is for informational purposes only. For official verification, use the NPPES NPI Registry.