Provider Demographics
NPI:1043293848
Name:LOPEZ ALMODOVAR, CARLOS EUGENIO (MD)
Entity Type:Individual
Prefix:
First Name:CARLOS
Middle Name:EUGENIO
Last Name:LOPEZ ALMODOVAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:CARLOS
Other - Middle Name:E
Other - Last Name:LOPEZ ALMODOVAR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 363095
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00936-3095
Mailing Address - Country:US
Mailing Address - Phone:787-749-9200
Mailing Address - Fax:787-790-1021
Practice Address - Street 1:#1051 CALLE 3 SE LA RIVIERA
Practice Address - Street 2:COND MEDICAL CENTER PLAZA SUITE #13
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00921
Practice Address - Country:US
Practice Address - Phone:787-749-9200
Practice Address - Fax:787-790-1021
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-25
Last Update Date:2009-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3198207R00000X, 207RA0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0201XAllopathic & Osteopathic PhysiciansInternal MedicineAllergy & Immunology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR94756OtherTRIPLE S
PR7910084OtherHUMANA INS
PR7910084OtherHUMANA INS
PR0094756Medicare ID - Type Unspecified