Healthcare Provider Details

I. General information

NPI: 1174456024
Provider Name (Legal Business Name): AVITA HOUSE CALL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2026
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6965 W AIRE LIBRE AVE
PEORIA AZ
85382-3987
US

IV. Provider business mailing address

6965 W AIRE LIBRE AVE
PEORIA AZ
85382-3987
US

V. Phone/Fax

Practice location:
  • Phone: 623-251-2855
  • Fax:
Mailing address:
  • Phone: 623-251-2855
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: MS. NICOLE OPREA
Title or Position: OWNER
Credential: P.A
Phone: 623-251-2855