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MIRA VITA METAMOPHOSIS, LLC
NPI 1073910873
Internal Medicine in Glendale, AZ

Active since November 24, 2014
5620 W THUNDERBIRD RD STE H2, GLENDALE, AZ 85306(480) 407-9007(833) 817-6790 Get Directions Write a Review

NPPES record last updated: January 30, 2020. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Mira Vita Metamophosis, Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MIRA VITA METAMOPHOSIS, LLC (NPI 1073910873) is a healthcare organization registered as an internal medicine in Glendale, Arizona and active in the NPI registry since November 2014. The organization lists Angela Marie Derosa, Owner, as its authorized official.

NPPES Registry Identity

NPI1073910873
Entity TypeOrganization
Primary Taxonomy207R00000X
Legal Business NameMIRA VITA METAMOPHOSIS, LLC
Location Address5620 W THUNDERBIRD RD STE H2Glendale, AZ 85306-4653
Mailing Address5620 W Thunderbird Rd Ste H2Glendale, AZ 85306-4653 · (480) 407-9007 · Fax (833) 817-6790
Phone(480) 407-9007
Fax(833) 817-6790
Organization SubpartNo
Authorized OfficialAngela Marie DerosaOwner · (480) 619-4097
Enumeration DateNovember 24, 2014
Last NPPES UpdateJanuary 30, 2020
✔ NPI 1073910873 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyInternal MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207R00000X
License✔ Licensed in AZ · 4223
Definition
A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs.
5620 W THUNDERBIRD RD STE H2, Glendale, AZ 85306
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Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

Other Providers at the Same Location NPPES

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. MARY E MONTES DNP, FNP-C
Nurse Practitioner (Family)
5620 W THUNDERBIRD RD STE H2
GLENDALE, AZ 85306
Maricopa County (480) 407-9007

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Mira Vita Metamophosis, LLC's NPI number?

The NPI number for Mira Vita Metamophosis, LLC is 1073910873. It was assigned to this organization in the NPPES registry on November 24, 2014.

Where is Mira Vita Metamophosis, LLC located?

Mira Vita Metamophosis, LLC is located at 5620 W Thunderbird Rd Ste H2, Glendale, AZ 85306. The listed phone number is (480) 407-9007.

What is Mira Vita Metamophosis, LLC's specialty?

The primary specialty registered for this NPI is Internal Medicine with taxonomy code 207R00000X.

When was this NPI record last updated?

The NPPES record for Mira Vita Metamophosis, LLC was last updated on January 30, 2020. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 6 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.