Healthcare Provider Details

I. General information

NPI: 1740216530
Provider Name (Legal Business Name): NELSON ALMODOVAR-RODRIGUEZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: NELSON ALMODOVAR-RODRIGUEZ M.D.

II. Dates (important events)

Enumeration Date: 06/23/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 AVE WINSTON CHURCHILL CROWN HILLS
SAN JUAN PR
00926-6013
US

IV. Provider business mailing address

293 PASEO DEL FLAMBOYAN EL VALLE
CAGUAS PR
00727-3220
US

V. Phone/Fax

Practice location:
  • Phone: 787-763-6166
  • Fax:
Mailing address:
  • Phone: 787-977-0537
  • Fax: 787-721-3646

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number9000
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: