Healthcare Provider Details

I. General information

NPI: 1659596427
Provider Name (Legal Business Name): MARIA T BOBONIS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

INSTITUTO SAN PABLO SUITE 308
BAYAMON PR
00961
US

IV. Provider business mailing address

PO BOX 11987 CABARRA STATION
SAN JUAN PR
00922-1987
US

V. Phone/Fax

Practice location:
  • Phone: 787-780-6237
  • Fax: 787-780-6374
Mailing address:
  • Phone: 787-780-6237
  • Fax: 787-780-6374

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number2447
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: