Provider Demographics
NPI:1437593100
Name:VESTAL, VERONICA ALANA (MD)
Entity Type:Individual
Prefix:
First Name:VERONICA
Middle Name:ALANA
Last Name:VESTAL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7056 VIA PLAYERA
Mailing Address - Street 2:
Mailing Address - City:TOA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00949-4360
Mailing Address - Country:US
Mailing Address - Phone:787-533-1093
Mailing Address - Fax:
Practice Address - Street 1:7056 VIA PLAYERA
Practice Address - Street 2:
Practice Address - City:TOA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00949-4360
Practice Address - Country:US
Practice Address - Phone:787-533-1093
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-24
Last Update Date:2024-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR21054207R00000X, 207RH0003X
MEMD27963207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRM1971OtherPTAN