Provider Demographics
NPI:1619902640
Name:ALMODOVAR PUANTONG, EVELYN S (MD)
Entity Type:Individual
Prefix:
First Name:EVELYN
Middle Name:S
Last Name:ALMODOVAR PUANTONG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:609 AVE TITO CASTRO
Mailing Address - Street 2:STE 102 PMB 222
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00716-0200
Mailing Address - Country:US
Mailing Address - Phone:787-844-6230
Mailing Address - Fax:787-848-4737
Practice Address - Street 1:2907 AVE EMILIO FAGOT
Practice Address - Street 2:
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00716-3613
Practice Address - Country:US
Practice Address - Phone:787-844-6230
Practice Address - Fax:787-848-4737
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR15056207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR15056OtherPR LICENSE