Basic Information
| Provider Information | |||||||||
| NPI: | 1801182092 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ALMODOVAR FABREGAS | ||||||||
| FirstName: | JUAN | ||||||||
| MiddleName: | GERARDO | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 19617 | ||||||||
| Address2: | |||||||||
| City: | SAN JUAN | ||||||||
| State: | PR | ||||||||
| PostalCode: | 009101617 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7876858649 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1462 CALLE PROF AUGUSTO RODRIGUEZ | ||||||||
| Address2: | |||||||||
| City: | SAN JUAN | ||||||||
| State: | PR | ||||||||
| PostalCode: | 00909 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7876411616 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/26/2011 | ||||||||
| LastUpdateDate: | 10/22/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208D00000X | 19044 | PR | Y | Allopathic & Osteopathic Physicians | General Practice |
ID Information
| ID | Type | State | Issuer | Description | 19044 | 01 | PR | LISENCE NUMBER | OTHER |