Healthcare Provider Details

I. General information

NPI: 1811199516
Provider Name (Legal Business Name): UBALDO BOCANEGRA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/04/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 AM#13 URB. PRADERAS
TOA BAJA PR
00949
US

IV. Provider business mailing address

15 S.E.# 767 CAPARRA TERRACE,RIO PIEDRAS
SAN JUAN PR
00921
US

V. Phone/Fax

Practice location:
  • Phone: 787-261-0959
  • Fax:
Mailing address:
  • Phone: 787-783-0643
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084D0003X
TaxonomyDiagnostic Neuroimaging (Psychiatry & Neurology) Physician
License Number5565
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: