Healthcare Provider Details

I. General information

NPI: 1174433346
Provider Name (Legal Business Name): JANICE MARIE ALMODOVAR CRESPO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/10/2026
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HC 3 BOX 34813
SAN SEBASTIAN PR
00685-7510
US

IV. Provider business mailing address

HC 3 BOX 34813
SAN SEBASTIAN PR
00685-7510
US

V. Phone/Fax

Practice location:
  • Phone: 787-618-3196
  • Fax:
Mailing address:
  • Phone: 787-618-3196
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number3294-P.A.
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: