Healthcare Provider Details

I. General information

NPI: 1124017488
Provider Name (Legal Business Name): PABLO IVAN ALMODOVAR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/19/2005
Last Update Date: 04/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

611 STREET PAVIA SUITE 201
SAN JUAN PR
00909-2242
US

IV. Provider business mailing address

611 CALLE PAVIA SUITE 201
SAN JUAN PR
00909-2242
US

V. Phone/Fax

Practice location:
  • Phone: 787-727-5892
  • Fax: 787-268-3620
Mailing address:
  • Phone: 787-727-5892
  • Fax: 787-268-3620

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number3519
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: