Healthcare Provider Details

I. General information

NPI: 1619902640
Provider Name (Legal Business Name): EVELYN S ALMODOVAR PUANTONG MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2907 AVE EMILIO FAGOT
PONCE PR
00716-3613
US

IV. Provider business mailing address

609 AVE TITO CASTRO STE 102 PMB 222
PONCE PR
00716-0200
US

V. Phone/Fax

Practice location:
  • Phone: 787-844-6230
  • Fax: 787-848-4737
Mailing address:
  • Phone: 787-844-6230
  • Fax: 787-848-4737

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number15056
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: