Provider Demographics
NPI:1861508129
Name:BISONO-BIDO, JUANA D (MD)
Entity type:Individual
Prefix:DR
First Name:JUANA
Middle Name:D
Last Name:BISONO-BIDO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:430 CALLE RUISENOR
Mailing Address - Street 2:CAMINOS DEL SUR
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00716-2829
Mailing Address - Country:US
Mailing Address - Phone:787-844-7027
Mailing Address - Fax:787-844-6888
Practice Address - Street 1:CAMINO DEL SUR
Practice Address - Street 2:CALLE RUISENOR NUM 430
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00716
Practice Address - Country:US
Practice Address - Phone:787-344-7920
Practice Address - Fax:787-813-8111
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2020-09-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PR14327208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRH97258Medicare UPIN