=====================================================
General NPI Number Information
=====================================================
NPI Number | 1740216530
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | NELSON ALMODOVAR-RODRIGUEZ M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/23/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 160 AVE WINSTON CHURCHILL CROWN HILLS
-----------------------------------------------------
City | SAN JUAN
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00926-6013
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-763-6166
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 293 PASEO DEL FLAMBOYAN EL VALLE
-----------------------------------------------------
City | CAGUAS
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00727-3220
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-977-0537
-----------------------------------------------------
Fax | 787-721-3646
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208000000X
-----------------------------------------------------
Taxonomy Name | Pediatrics Physician
-----------------------------------------------------
License Number | 9000
-----------------------------------------------------
License Number State | PR
-----------------------------------------------------