Healthcare Provider Details

I. General information

NPI: 1508874876
Provider Name (Legal Business Name): JOSE I ALMODOVAR - LABORDE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/03/2006
Last Update Date: 03/13/2024
Certification Date: 03/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR. 2 KM 174.0 SAN GERMAN MEDICAL PLAZA SUITE 207
SAN GERMAN PR
00683-9340
US

IV. Provider business mailing address

HC 3 BOX 25716 SAN GERMAN MEDICAL PAZA
SAN GERMAN PR
00683-9340
US

V. Phone/Fax

Practice location:
  • Phone: 787-892-3513
  • Fax: 787-892-7422
Mailing address:
  • Phone: 787-892-3513
  • Fax: 787-892-7422

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0007X
TaxonomyPlastic Surgery within the Head & Neck (Otolaryngology) Physician
License Number11632
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: