Provider Demographics
NPI:1487852125
Name:CRISTOBAL, PURIFICACION (DNP, PNP, FNP& PSYC)
Entity Type:Individual
Prefix:DR
First Name:PURIFICACION
Middle Name:
Last Name:CRISTOBAL
Suffix:
Gender:F
Credentials:DNP, PNP, FNP& PSYC
Other - Prefix:DR
Other - First Name:PURIFICACION
Other - Middle Name:
Other - Last Name:CRISTOBAL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DNP, APRN, PSYCHIAT
Mailing Address - Street 1:3250 WESTCHESTER AVENUE
Mailing Address - Street 2:SUITE LL4
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10461-4500
Mailing Address - Country:US
Mailing Address - Phone:718-684-6465
Mailing Address - Fax:718-684-6467
Practice Address - Street 1:3250 WESTCHESTER AVENUE
Practice Address - Street 2:SUITE LL4
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-4500
Practice Address - Country:US
Practice Address - Phone:718-684-6465
Practice Address - Fax:718-684-6467
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-03
Last Update Date:2019-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY4022332084P0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0802XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction PsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY05459852Medicaid