Healthcare Provider Details

I. General information

NPI: 1750712766
Provider Name (Legal Business Name): VALLE DEL SOL, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/02/2013
Last Update Date: 11/02/2021
Certification Date: 11/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3807 N 7TH ST
PHOENIX AZ
85014
US

IV. Provider business mailing address

3877 N 7TH ST STE 400
PHOENIX AZ
85014-5061
US

V. Phone/Fax

Practice location:
  • Phone: 602-258-6797
  • Fax: 602-248-8113
Mailing address:
  • Phone: 602-258-6797
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License NumberOTC-5327
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License NumberBH-3165
License Number StateAZ
# 3
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: REBECCA RAZO
Title or Position: CONTRACTS DIRECTOR
Credential:
Phone: 602-258-6797