Provider Demographics
NPI:1811771272
Name:CRISTOBAL, MIGUEL ANGEL (NL)
Entity type:Individual
Prefix:MR
First Name:MIGUEL
Middle Name:ANGEL
Last Name:CRISTOBAL
Suffix:
Gender:M
Credentials:NL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:503 CARR 733
Mailing Address - Street 2:
Mailing Address - City:CIDRA
Mailing Address - State:PR
Mailing Address - Zip Code:00739-2396
Mailing Address - Country:US
Mailing Address - Phone:787-436-9651
Mailing Address - Fax:
Practice Address - Street 1:CALLE SAN LUCAS A 10 URB. SAN PEDRO
Practice Address - Street 2:
Practice Address - City:TOA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00949-5401
Practice Address - Country:US
Practice Address - Phone:787-436-9651
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-24
Last Update Date:2023-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR222175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath