Provider Demographics
NPI:1053607309
Name:BAYONA SASTRE, MARIBEL (MED MPSYD)
Entity type:Individual
Prefix:
First Name:MARIBEL
Middle Name:
Last Name:BAYONA SASTRE
Suffix:
Gender:F
Credentials:MED MPSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2167
Mailing Address - Street 2:
Mailing Address - City:VEGA ALTA
Mailing Address - State:PR
Mailing Address - Zip Code:00692-2167
Mailing Address - Country:US
Mailing Address - Phone:787-402-9061
Mailing Address - Fax:
Practice Address - Street 1:URB CALLE SANTA CRUZ F17
Practice Address - Street 2:
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00959
Practice Address - Country:US
Practice Address - Phone:787-402-9061
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-24
Last Update Date:2011-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3503103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist