Provider Demographics
NPI:1972572832
Name:HESS, IVIA ITSA (MD)
Entity Type:Individual
Prefix:DR
First Name:IVIA
Middle Name:ITSA
Last Name:HESS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:IVIA
Other - Middle Name:ITSA
Other - Last Name:LANDRO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:6301 S MCCLINTOCK DR STE 101
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85283-3393
Mailing Address - Country:US
Mailing Address - Phone:480-214-2300
Mailing Address - Fax:480-214-2301
Practice Address - Street 1:2550 E GUADALUPE RD STE 115
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85234-5114
Practice Address - Country:US
Practice Address - Phone:480-632-1544
Practice Address - Fax:480-632-1533
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2019-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ24191208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ360157OtherAHCCCS ID NUMBER
AZ360157OtherAHCCCS ID NUMBER