=====================================================
General NPI Number Information
=====================================================
NPI Number | 1043293848
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CARLOS EUGENIO LOPEZ ALMODOVAR MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/25/2005
-----------------------------------------------------
Last Update Date | 03/05/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | #1051 CALLE 3 SE LA RIVIERA COND MEDICAL CENTER PLAZA SUITE #13
-----------------------------------------------------
City | SAN JUAN
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00921
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-749-9200
-----------------------------------------------------
Fax | 787-790-1021
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 363095
-----------------------------------------------------
City | SAN JUAN
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00936-3095
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-749-9200
-----------------------------------------------------
Fax | 787-790-1021
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | 3198
-----------------------------------------------------
License Number State | PR
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207RA0201X
-----------------------------------------------------
Taxonomy Name | Allergy & Immunology (Internal Medicine) Physician
-----------------------------------------------------
License Number | 3198
-----------------------------------------------------
License Number State | PR
-----------------------------------------------------