Healthcare Provider Details

I. General information

NPI: 1811817752
Provider Name (Legal Business Name): VERONICA AVITIA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2026
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 W LORD ST
TUCSON AZ
85705-7500
US

IV. Provider business mailing address

650 W LORD ST
TUCSON AZ
85705-7500
US

V. Phone/Fax

Practice location:
  • Phone: 520-250-8844
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License NumberADBH20017
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code385H00000X
TaxonomyRespite Care
License NumberADBH20017
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: