Healthcare Provider Details

I. General information

NPI: 1497690549
Provider Name (Legal Business Name): CITRUS VILLA MESA ASSISTED LIVING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2026
Last Update Date: 04/23/2026
Certification Date: 04/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6848 E MINTON ST
MESA AZ
85207-1098
US

IV. Provider business mailing address

10719 E TESLA AVE
MESA AZ
85212-8663
US

V. Phone/Fax

Practice location:
  • Phone: 760-464-6386
  • Fax:
Mailing address:
  • Phone: 760-464-6386
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. ERICK SOTELO
Title or Position: OWNER
Credential:
Phone: 760-464-6386