Provider Demographics
NPI:1497239974
Name:ALMODOVAR, EMITSABEL
Entity Type:Individual
Prefix:MRS
First Name:EMITSABEL
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:PO BOX 209
Mailing Address - Street 2:
Mailing Address - City:ENSENADA
Mailing Address - State:PR
Mailing Address - Zip Code:00647-0209
Mailing Address - Country:US
Mailing Address - Phone:787-249-6022
Mailing Address - Fax:
Practice Address - Street 1:F14 URB VALLE TANIA
Practice Address - Street 2:
Practice Address - City:ENSENADA
Practice Address - State:PR
Practice Address - Zip Code:00647-0209
Practice Address - Country:US
Practice Address - Phone:787-249-6022
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-20
Last Update Date:2018-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PRPCTPC-PROV343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR66-0900832OtherSOEMY INC.