Provider Demographics
NPI:1063491041
Name:VITERI-GIORDANO, MONICA ELIZABETH (DO)
Entity type:Individual
Prefix:DR
First Name:MONICA
Middle Name:ELIZABETH
Last Name:VITERI-GIORDANO
Suffix:
Gender:F
Credentials:DO
Other - Prefix:MRS
Other - First Name:MONICA
Other - Middle Name:E
Other - Last Name:VITERI-GIORDANO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:37100 N. GANTZEL ROAD STE #201
Mailing Address - Street 2:
Mailing Address - City:SAN TAN VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85140
Mailing Address - Country:US
Mailing Address - Phone:480-394-4469
Mailing Address - Fax:480-394-4527
Practice Address - Street 1:1300 N 12TH ST STE 508
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85006-2849
Practice Address - Country:US
Practice Address - Phone:602-839-4777
Practice Address - Fax:602-839-4233
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-10
Last Update Date:2013-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZR1684207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ409822Medicaid
AZR 1684OtherARIZONA OSTEOPATHIC TRAINING PERMIT NUMBER/ LICENSE NUMBER
AZR 1684OtherARIZONA OSTEOPATHIC TRAINING PERMIT NUMBER/ LICENSE NUMBER
AZ105927Medicare PIN