Provider Demographics
NPI:1548409816
Name:ADRIANO, MIA ISADORA ESMUNDO (MD, MPH)
Entity Type:Individual
Prefix:
First Name:MIA ISADORA
Middle Name:ESMUNDO
Last Name:ADRIANO
Suffix:
Gender:F
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2501 E SOUTHERN AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85282-7666
Mailing Address - Country:US
Mailing Address - Phone:602-337-5609
Mailing Address - Fax:602-214-6149
Practice Address - Street 1:2501 E SOUTHERN AVE STE 1
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-7666
Practice Address - Country:US
Practice Address - Phone:602-337-5609
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-10
Last Update Date:2023-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ42351207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine