Provider Demographics
NPI:1679153654
Name:REBON, GENEVIEVE MARIAH (DO)
Entity type:Individual
Prefix:
First Name:GENEVIEVE
Middle Name:MARIAH
Last Name:REBON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:GENEVIEVE
Other - Middle Name:MARIAH
Other - Last Name:MARTIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:4301 BROADWAY # ST121
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78209-6318
Mailing Address - Country:US
Mailing Address - Phone:210-619-7105
Mailing Address - Fax:
Practice Address - Street 1:250 E BASSE RD STE 206
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78209-8409
Practice Address - Country:US
Practice Address - Phone:210-826-7447
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-13
Last Update Date:2025-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXU08332084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry