Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | DN1857504 | MA |
Y | 1223P0300X | Periodontist | 003319 | PR |
NPI | 1134583693 |
---|---|
Provider Name | Alberto Ivan Almodovar |
First Address | Mayaguez, PR 00681-2896 |
Second Address | Mayaguez, PR 00680-5497 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/04/2016 |
Last Update Date | 12/02/2021 |