Provider Demographics
NPI:1235980863
Name:ALMODOVAR, IVAN ANDRES
Entity Type:Individual
Prefix:
First Name:IVAN
Middle Name:ANDRES
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 1:1286 CALLE CLARISAS
Mailing Address - Street 2:
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00730-4038
Mailing Address - Country:US
Mailing Address - Phone:787-619-8731
Mailing Address - Fax:
Practice Address - Street 1:1286 CALLE CLARISAS
Practice Address - Street 2:
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00730-4038
Practice Address - Country:US
Practice Address - Phone:787-619-8731
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-01
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program