Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | 22090 | PR |
N | 208000000X | Pediatrician | 22090 | PR |
NPI | 1093176927 |
---|---|
Provider Name | Veronica Cristina Diaz Vidal |
First Address | San Juan, PR 00926-3908 |
Second Address | Bayamon, PR 00959-9002 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/03/2016 |
Last Update Date | 07/07/2021 |