Healthcare Provider Details

I. General information

NPI: 1972572832
Provider Name (Legal Business Name): IVIA ITSA HESS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: IVIA ITSA LANDRO MD

II. Dates (important events)

Enumeration Date: 03/14/2006
Last Update Date: 05/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2550 E GUADALUPE RD STE 115
GILBERT AZ
85234-5114
US

IV. Provider business mailing address

6301 S MCCLINTOCK DR STE 101
TEMPE AZ
85283-3393
US

V. Phone/Fax

Practice location:
  • Phone: 480-632-1544
  • Fax: 480-632-1533
Mailing address:
  • Phone: 480-214-2300
  • Fax: 480-214-2301

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number24191
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: