Basic Information
| Provider Information | |||||||||
| NPI: | 1750712766 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | VALLE DEL SOL, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3877 N 7TH ST STE 400 | ||||||||
| Address2: | |||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850145061 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6022586797 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3807 N 7TH ST | ||||||||
| Address2: | |||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 85014 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6022586797 | ||||||||
| FaxNumber: | 6022488113 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/02/2013 | ||||||||
| LastUpdateDate: | 11/02/2021 | ||||||||
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| AuthorizedOfficialLastName: | RAZO | ||||||||
| AuthorizedOfficialFirstName: | REBECCA | ||||||||
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| AuthorizedOfficialTitleorPosition: | CONTRACTS DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 6022586797 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 11/02/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QH0100X | OTC-5327 | AZ | N | Ambulatory Health Care Facilities | Clinic/Center | Health Service | 261QH0100X | BH-3165 | AZ | N | Ambulatory Health Care Facilities | Clinic/Center | Health Service | 251S00000X | Y | Agencies | Community/Behavioral Health |
No ID Information.