Healthcare Provider Details

I. General information

NPI: 1528907086
Provider Name (Legal Business Name): SAMANTHA ROSE AVERA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2026
Last Update Date: 03/27/2026
Certification Date: 03/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26224 N TATUM BLVD STE 5
PHOENIX AZ
85050-7500
US

IV. Provider business mailing address

7400 E THOMPSON PEAK PKWY
SCOTTSDALE AZ
85255-4109
US

V. Phone/Fax

Practice location:
  • Phone: 480-882-7580
  • Fax: 480-563-7442
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: