Healthcare Provider Details

I. General information

NPI: 1487852125
Provider Name (Legal Business Name): PURIFICACION CRISTOBAL DNP, PNP, FNP& PSYC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: PURIFICACION CRISTOBAL DNP, APRN, PSYCHIAT

II. Dates (important events)

Enumeration Date: 07/03/2007
Last Update Date: 10/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3250 WESTCHESTER AVENUE SUITE LL4
BRONX NY
10461-4500
US

IV. Provider business mailing address

3250 WESTCHESTER AVENUE SUITE LL4
BRONX NY
10461-4500
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 Number402233
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: