Provider Demographics
NPI:1093079980
Name:ALMODOVAR, PABLO EDGARDO
Entity Type:Individual
Prefix:DR
First Name:PABLO
Middle Name:EDGARDO
Last Name:ALMODOVAR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:67 MONTALVA
Mailing Address - Street 2:
Mailing Address - City:ENSENADA
Mailing Address - State:PR
Mailing Address - Zip Code:00647
Mailing Address - Country:US
Mailing Address - Phone:787-821-0571
Mailing Address - Fax:
Practice Address - Street 1:POP-V PFIZER TOWER, 996 SAN ROBERTO ST
Practice Address - Street 2:SUITE 301
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00647
Practice Address - Country:US
Practice Address - Phone:787-641-0773
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-26
Last Update Date:2012-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR39103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical