Healthcare Provider Details

I. General information

NPI: 1093176927
Provider Name (Legal Business Name): VERONICA CRISTINA DIAZ VIDAL M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2016
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:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number22090
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number22090
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: