Provider Demographics
NPI:1326566415
Name:PVD DIAGNOSTICS, LLC
Entity Type:Organization
Organization Name:PVD DIAGNOSTICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:VAN DELDEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:210-445-4450
Mailing Address - Street 1:PO BOX 690804
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78269-0804
Mailing Address - Country:US
Mailing Address - Phone:210-451-7525
Mailing Address - Fax:210-451-7526
Practice Address - Street 1:18007 W IH 10
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78257-9536
Practice Address - Country:US
Practice Address - Phone:210-451-7525
Practice Address - Fax:210-451-7526
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-08
Last Update Date:2022-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory