Healthcare Provider Details

I. General information

NPI: 1225993322
Provider Name (Legal Business Name): AGAVIA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2025
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2427 W DESERT HILLS ESTATE DR
PHOENIX AZ
85086-4338
US

IV. Provider business mailing address

2427 W DESERT HILLS ESTATE DR
PHOENIX AZ
85086-4338
US

V. Phone/Fax

Practice location:
  • Phone: 623-252-2421
  • Fax:
Mailing address:
  • Phone: 623-252-2421
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: MERLIS OLIVEROS GUERRA
Title or Position: OWNER
Credential: NURSE PRACTITIONER
Phone: 623-252-2421