Provider Demographics
NPI:1922896968
Name:ORTIZ SEGURA, KRYSTAL CELESTE
Entity type:Individual
Prefix:
First Name:KRYSTAL
Middle Name:CELESTE
Last Name:ORTIZ SEGURA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2861 ROEBLING AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10461-5491
Mailing Address - Country:US
Mailing Address - Phone:929-453-7961
Mailing Address - Fax:
Practice Address - Street 1:2861 ROEBLING AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-5491
Practice Address - Country:US
Practice Address - Phone:929-453-7961
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-29
Last Update Date:2025-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty