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General NPI Number Information
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NPI Number | 1326566415
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Entity Type | Organization
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Legal Business Name | PVD DIAGNOSTICS, LLC
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Dates
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Enumeration Date | 09/08/2017
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Last Update Date | 10/21/2022
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Provider Practice Location Address
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Address Line | 18007 W IH 10
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City | SAN ANTONIO
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State | TX
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Zip | 78257-9536
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Country | US
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Telephone | 210-451-7525
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Fax | 210-451-7526
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Provider Business Mailing Address
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Address Line | PO BOX 690804
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City | SAN ANTONIO
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State | TX
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Zip | 78269-0804
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Country | US
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Telephone | 210-451-7525
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Fax | 210-451-7526
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Authorized Official
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Title or Position | CEO
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Name | PETER VAN DELDEN
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Credential | MD
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Telephone | 210-445-4450
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number |
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License Number State |
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