Provider Demographics
NPI:1225317944
Name:VALLE DEL SOL, INC.
Entity Type:Organization
Organization Name:VALLE DEL SOL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTRACTS DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:
Authorized Official - Last Name:RAZO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-258-6797
Mailing Address - Street 1:3877 N 7TH ST STE 400
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85014-5061
Mailing Address - Country:US
Mailing Address - Phone:602-258-6797
Mailing Address - Fax:602-248-8113
Practice Address - Street 1:1209 S 1ST AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85003-2605
Practice Address - Country:US
Practice Address - Phone:602-258-6797
Practice Address - Fax:602-254-7121
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-11
Last Update Date:2021-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QF0400X
AZOTC5153261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)