Healthcare Provider Details

I. General information

NPI: 1750596789
Provider Name (Legal Business Name): MIRELLA M. MIRCESCU M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/12/2007
Last Update Date: 10/07/2025
Certification Date: 10/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 W THOMAS RD STE 900B
PHOENIX AZ
85013-4223
US

IV. Provider business mailing address

PO BOX 33269
PHOENIX AZ
85067-3269
US

V. Phone/Fax

Practice location:
  • Phone: 602-406-4300
  • Fax: 602-406-3134
Mailing address:
  • Phone: 602-406-4786
  • Fax: 916-636-4358

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number38189
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number38189
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: