Provider Demographics
NPI:1780447581
Name:SMALL VALLEY HEALTHCARE PARTNERS
Entity type:Organization
Organization Name:SMALL VALLEY HEALTHCARE PARTNERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:JUVEL-LOU
Authorized Official - Middle Name:P
Authorized Official - Last Name:VELASCO
Authorized Official - Suffix:
Authorized Official - Credentials:APRN-ANP
Authorized Official - Phone:443-791-7069
Mailing Address - Street 1:4743 N 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85718-5610
Mailing Address - Country:US
Mailing Address - Phone:520-878-8233
Mailing Address - Fax:520-540-2266
Practice Address - Street 1:4743 N 1ST AVE
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85718-5610
Practice Address - Country:US
Practice Address - Phone:520-878-8233
Practice Address - Fax:520-540-2266
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-05
Last Update Date:2025-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
No261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care