Healthcare Provider Details

I. General information

NPI: 1609448083
Provider Name (Legal Business Name): VD ALLERGY INSTITUTE LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2021
Last Update Date: 01/06/2025
Certification Date: 01/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 AVE DOMENECH STE 408
SAN JUAN PR
00918-3706
US

IV. Provider business mailing address

94 RAMAL 842 APT 127
SAN JUAN PR
00926-3908
US

V. Phone/Fax

Practice location:
  • Phone: 787-622-2012
  • Fax: 713-554-2137
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. VERONICA C DIAZ VIDAL
Title or Position: ALLERGIST IMMUNOLOGIST
Credential: MD
Phone: 787-764-4309