NPIMap

Organization Active NPI

Valle del Sol, Inc.

  • Federally Qualified Health Center (FQHC)
  • Mesa, AZ
National Provider Identifier
1881198992
Registry record updated Jun 7, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
VALLE DEL SOL, INC.
Practice address
334 W 10TH PL Ste 100
Mesa, AZ 85201-3499
Phone
(602) 258-6797
Fax
(602) 248-8113
NPI assigned
Mar 22, 2018
Last updated
Jun 7, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 7, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Rebecca Razo
Title
Director of Contracts
Phone
(602) 258-6797

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

334 W 10TH PL Ste 100
Mesa, AZ 85201-3499

Mailing address

3877 N 7TH St Ste 400
Phoenix, AZ 85014-5061
Phone (602) 258-6797

Other identifiers 1

IdentifierTypeStateIssuer
871351MedicaidAZ

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20050516000299 AZ Part B Supplier - Clinic/Group Practice 8628019148 Receives reassigned benefits from 76 practitioners
15 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Phoenix, AZ; Mesa, AZ
O20180402000429 AZ Part A Provider - Federally Qualified Health Center (FQHC) 8628019148 Practice locations: Mesa, AZ

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1881198992. Details of each certification follow.

Federally qualified health center certification: CCN 031972

Legal name
VALLE DEL SOL INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Apr 2, 2018
Last certification
Apr 2, 2018
Ownership / control type
Non-profit – church related
Organization structure
CorporationNon-profit
Incorporated
Dec 9, 1970 in AZ
Enrollment address
334 W 10TH PL
Ste 100
Mesa, AZ 85201-3499

Other NPIs with the same Medicare PAC ID 9

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 12

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Valle del Sol17 organizations share this tax ID, including this one

Other organizations with this tax ID 16

Organizations that report the same tax identification number in the National Provider Directory.

View all 16

Ownership & related parties

All disclosed owners & managing parties 17

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
June Campbell Individual Corporate DirectorBoard Member Jan 1, 2021
Andrew Cooper Individual Corporate DirectorBoard Member Jan 1, 2021
Margarita Silva Individual Corporate DirectorBoard Member Jul 1, 2023
Manuel Calero Individual Corporate DirectorBoard Member Jan 1, 2021
Teri Leon Individual Corporate DirectorBoard Member Jul 14, 2023
Berta Carbajal Individual Corporate DirectorBoard Member May 1, 2022
Sumit Chohan Individual Corporate OfficerCfo Sep 18, 2023
Operational/Managerial Control Sep 18, 2023
Shelli Ross Individual Corporate OfficerCoo Mar 15, 2021
W-2 Managing Employee Mar 15, 2021
Florentino Gabriel Licon Individual Corporate DirectorBoard Member May 1, 2018
Michael Renaud Individual Corporate OfficerCeo Jul 10, 2023
W-2 Managing Employee Jul 10, 2023
Operational/Managerial Control Jul 10, 2023
Rebecca Razo Individual W-2 Managing Employee May 7, 2018
Virginia Valenzuela Individual Corporate DirectorBoard Member Jan 1, 2023
Diana Ixchel del Castillo Medina Individual Corporate DirectorBoard Member May 1, 2018
Linda McPhaul Individual Corporate DirectorBoard Member May 1, 2018
Valle del Sol Inc Organization, Phoenix, AZ Corporation, Non-profit Other May 1, 2018
Laura Balderrama Individual Corporate DirectorBoard Member Jan 1, 2023
Richard Kautz Individual Corporate DirectorBoard Member Jan 1, 2023

Owners & managing parties with NPI records 9

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

All facility ownership & control disclosures 6

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Valle del Sol IncPhoenix, AZ, CCN 031921 Federally qualified health center Operational/Managerial Control Sep 4, 2018
Valle del Sol IncPhoenix, AZ, CCN 031922 Federally qualified health center Operational/Managerial Control Feb 16, 2015
Valle del Sol IncPhoenix, AZ, CCN 031954 Federally qualified health center Other Jul 24, 2017
Valle del Sol IncPhoenix, AZ, CCN 031986 Federally qualified health center Operational/Managerial Control Nov 1, 2019
Valle del Sol IncMesa, AZ, CCN 031006 Federally qualified health center Operational/Managerial Control Dec 9, 1970
Valle del Sol IncPhoenix, AZ, CCN 031063 Federally qualified health center Operational/Managerial Control Aug 5, 2025

Owned or controlled facilities with NPI records 6

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Practitioners & affiliated clinicians

Practitioners 9

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1521676800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1717718400000",
    "number": "1881198992",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3877 N 7TH ST STE 400",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850145061",
            "telephone_number": "602-258-6797"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "334 W 10TH PL STE 100",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852013499",
            "telephone_number": "602-258-6797",
            "fax_number": "602-248-8113"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VALLE DEL SOL, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-03-22",
        "last_updated": "2024-06-07",
        "certification_date": "2024-06-07",
        "status": "A",
        "authorized_official_last_name": "RAZO",
        "authorized_official_first_name": "REBECCA",
        "authorized_official_title_or_position": "DIRECTOR OF CONTRACTS",
        "authorized_official_telephone_number": "602-258-6797"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "871351",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Mesa, AZ

Sources for this page

Verify at the official NPI Registry.