Healthcare Provider Details

I. General information

NPI: 1326432238
Provider Name (Legal Business Name): KAMEHAMEHA HEALTH AND WELLNESS NONPROFIT CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2015
Last Update Date: 10/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3250 WESCHESTER AVENUE SUITE LL4
BRONX NY
10461-4548
US

IV. Provider business mailing address

3250 WESCHESTER AVENUE SUITE LL4
BRONX NY
10461-4548
US

V. Phone/Fax

Practice location:
  • Phone: 718-684-6465
  • Fax: 718-684-6467
Mailing address:
  • Phone: 718-684-6465
  • Fax: 718-684-6467

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. PURIFICACION CRISTOBAL
Title or Position: MANAGING AGENT
Credential: DNP, PHD
Phone: 718-684-6465