Healthcare Provider Details

I. General information

NPI: 1043293848
Provider Name (Legal Business Name): CARLOS EUGENIO LOPEZ ALMODOVAR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: CARLOS E LOPEZ ALMODOVAR MD

II. Dates (important events)

Enumeration Date: 11/25/2005
Last Update Date: 03/05/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

#1051 CALLE 3 SE LA RIVIERA COND MEDICAL CENTER PLAZA SUITE #13
SAN JUAN PR
00921
US

IV. Provider business mailing address

PO BOX 363095
SAN JUAN PR
00936-3095
US

V. Phone/Fax

Practice location:
  • Phone: 787-749-9200
  • Fax: 787-790-1021
Mailing address:
  • Phone: 787-749-9200
  • Fax: 787-790-1021

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number3198
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code207RA0201X
TaxonomyAllergy & Immunology (Internal Medicine) Physician
License Number3198
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: