Provider Demographics
NPI:1114009065
Name:ALMODOVAR OLMEDA, ROBERTO (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERTO
Middle Name:
Last Name:ALMODOVAR OLMEDA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 9 BOX 4492
Mailing Address - Street 2:
Mailing Address - City:SABANA GRANDE
Mailing Address - State:PR
Mailing Address - Zip Code:00637-9448
Mailing Address - Country:US
Mailing Address - Phone:787-892-6226
Mailing Address - Fax:787-892-6226
Practice Address - Street 1:9 CALLE ESPERANZA
Practice Address - Street 2:
Practice Address - City:SAN GERMAN
Practice Address - State:PR
Practice Address - Zip Code:00683-3903
Practice Address - Country:US
Practice Address - Phone:787-892-6226
Practice Address - Fax:787-892-6226
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-19
Last Update Date:2010-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR13977208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0020957Medicare ID - Type UnspecifiedPROVIDER