Provider Demographics
NPI:1275896110
Name:ALMODOVAR, EDWINA
Entity Type:Individual
Prefix:
First Name:EDWINA
Middle Name:
Last Name:ALMODOVAR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8577 DYKER HEIGHTS AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89178-8291
Mailing Address - Country:US
Mailing Address - Phone:702-614-8488
Mailing Address - Fax:
Practice Address - Street 1:2770 S MARYLAND PKWY STE 310
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89109-1566
Practice Address - Country:US
Practice Address - Phone:702-240-3800
Practice Address - Fax:702-240-3001
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-15
Last Update Date:2012-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant