Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Mira Vita Metamophosis, LLC

Organization Internal Medicine Physician · NPI 1073910873

Mira Vita Metamophosis, LLC is an Internal Medicine Physician in Glendale, Arizona. Licensed in Arizona. Registered with an NPI since 2014.

Licensed in
AZ
In the registry since
2014
Specialties on file
2
What do these letters mean?
LLC — Limited liability company
A form of business registration, not a clinical qualification.

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Practice location Address checks out

5620 W Thunderbird Rd Ste H2
Glendale, AZ 85306-4653
Phone: (480) 407-9007
Fax: (833) 817-6790
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Internal Medicine Physician (primary) Taxonomy 207R00000X · Licence 4223 (AZ)
Internal Medicine Physician Taxonomy 207R00000X

Record details

NPI number1073910873
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Angela Derosa — Owner · (480) 619-4097
NPI enumeratedNovember 24, 2014
Last updated in NPPESJanuary 30, 2020
Certification dateJanuary 30, 2020
Mailing address5620 W Thunderbird Rd Ste H2, Glendale, AZ 85306-4653

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