Provider Demographics
NPI:1679968754
Name:ROMAN ALMODOVAR, ELVIS SR (MS,SLP)
Entity Type:Individual
Prefix:
First Name:ELVIS
Middle Name:
Last Name:ROMAN ALMODOVAR
Suffix:SR
Gender:M
Credentials:MS,SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 1 BOX 7420
Mailing Address - Street 2:
Mailing Address - City:HATILLO
Mailing Address - State:PR
Mailing Address - Zip Code:00659-7342
Mailing Address - Country:US
Mailing Address - Phone:787-241-2197
Mailing Address - Fax:
Practice Address - Street 1:HC 1 BOX 7420
Practice Address - Street 2:
Practice Address - City:HATILLO
Practice Address - State:PR
Practice Address - Zip Code:00659-7342
Practice Address - Country:US
Practice Address - Phone:787-241-2197
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-05
Last Update Date:2015-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2066235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist