Healthcare Provider Details

I. General information

NPI: 1194635474
Provider Name (Legal Business Name): HEATHER SMALLWOOD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

7281 DUMOSA AVE STE 3&4
YUCCA VALLEY CA
92284-3769
US

IV. Provider business mailing address

7281 DUMOSA AVE STE 3AND4
YUCCA VALLEY CA
92284-3769
US

V. Phone/Fax

Practice location:
  • Phone: 760-853-4755
  • Fax: 760-513-9717
Mailing address:
  • Phone: 760-853-4755
  • Fax: 760-513-9717

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 StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: