Provider Demographics
NPI:1104037290
Name:BIBILONI, RAFAEL (MA)
Entity Type:Individual
Prefix:
First Name:RAFAEL
Middle Name:
Last Name:BIBILONI
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:URB SAN AGUSTIN
Mailing Address - Street 2:CALLE CABO G MEJIAS 358
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00923
Mailing Address - Country:US
Mailing Address - Phone:787-767-3149
Mailing Address - Fax:
Practice Address - Street 1:HOSP PSIQUIATRIA DR RAMON FERNANDEZ MARINA
Practice Address - Street 2:BO MONACILLO
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00922
Practice Address - Country:US
Practice Address - Phone:787-766-4646
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR247103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist