Healthcare Provider Details

I. General information

NPI: 1962312033
Provider Name (Legal Business Name): MARY LOU F VELASCO RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2026
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

351 W PLUM ST
NOGALES AZ
85621-2612
US

IV. Provider business mailing address

1327 W CALLE PAISANO
NOGALES AZ
85621-2402
US

V. Phone/Fax

Practice location:
  • Phone: 520-287-0800
  • Fax:
Mailing address:
  • Phone: 520-397-7910
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number25670290
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: