1609448083 NPI number — VD ALLERGY INSTITUTE LLC.

Table of content: (NPI 1609448083)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609448083 NPI number — VD ALLERGY INSTITUTE LLC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VD ALLERGY INSTITUTE LLC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1609448083
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/28/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
94 RAMAL 842 APT 127
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN JUAN
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00926-3908
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
553 CABO H. ALVERIO EXT. ROOSEVELT
Provider Second Line Business Practice Location Address:
EXT ROOSEVELT
Provider Business Practice Location Address City Name:
HATO REY
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00918-3725
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-764-4309
Provider Business Practice Location Address Fax Number:
787-756-5059
Provider Enumeration Date:
07/14/2021

Additional Information

Authorized Official

Authorized Official Last Name:
DIAZ VIDAL
Authorized Official First Name:
VERONICA
Authorized Official Middle Name:
C
Authorized Official Title or Position:
ALLERGIST IMMUNOLOGIST
Authorized Official Telephone Number:
787-764-4309

Provider Taxonomy Codes

  • Taxonomy code: 207K00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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