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General NPI Number Information
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NPI Number | 1619902640
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Entity Type | Individual
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Provider Name | EVELYN S ALMODOVAR PUANTONG MD
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Gender | Female
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Dates
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Enumeration Date | 07/11/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 2907 AVE EMILIO FAGOT
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City | PONCE
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State | PR
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Zip | 00716-3613
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Country | US
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Telephone | 787-844-6230
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Fax | 787-848-4737
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Provider Business Mailing Address
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Address Line | 609 AVE TITO CASTRO STE 102 PMB 222
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City | PONCE
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State | PR
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Zip | 00716-0200
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Country | US
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Telephone | 787-844-6230
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Fax | 787-848-4737
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 15056
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License Number State | PR
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