Basic Information
Provider Information
NPI: 1184855975
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: CRISTOBAL
FirstName: RONALD
MiddleName: S
NamePrefix:  
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
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OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
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OtherCredential:  
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Mailing Information
Address1: 3501 MILLS AVE
Address2: AMEP DEPARTMENT OF PSYCHIATRY
City: AUSTIN
State: TX
PostalCode: 787316309
CountryCode: US
TelephoneNumber: 5123242080
FaxNumber: 5123242084
Practice Location
Address1: 3501 MILLS AVE
Address2: AMEP DEPARTMENT OF PSYCHIATRY
City: AUSTIN
State: TX
PostalCode: 787316309
CountryCode: US
TelephoneNumber: 5123242080
FaxNumber: 5123242084
Other Information
ProviderEnumerationDate: 07/28/2009
LastUpdateDate: 07/28/2009
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
2084P0800XBP1-0035986TXY Allopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry

No ID Information.


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