Provider Demographics
NPI:1881198992
Name:VALLE DEL SOL, INC.
Entity Type:Organization
Organization Name:VALLE DEL SOL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICCER
Authorized Official - Prefix:
Authorized Official - First Name:CARMEN
Authorized Official - Middle Name:
Authorized Official - Last Name:HEREDIA
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:
Practice Address - Street 1:334 W 10TH PL STE 100
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85201-3499
Practice Address - Country:US
Practice Address - Phone:602-258-6797
Practice Address - Fax:602-248-8113
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-22
Last Update Date:2021-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ871351Medicaid