Healthcare Provider Details

I. General information

NPI: 1366412801
Provider Name (Legal Business Name): PABLO R BISONO RODRIGUEZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/26/2006
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

URB SANTA CRUZ B 10 CALLE SANTA CRUZ
BAYAMON PR
00961
US

IV. Provider business mailing address

PO BOX 363265
SAN JUAN PR
00936-3265
US

V. Phone/Fax

Practice location:
  • Phone: 787-786-3000
  • Fax: 787-200-6317
Mailing address:
  • Phone: 787-786-3000
  • Fax: 787-200-6317

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number10617
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: