1639129307 NPI number — ESTRELLA M POBLETE MD

Table of content: ESTRELLA M POBLETE MD (NPI 1639129307)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639129307 NPI number — ESTRELLA M POBLETE MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
POBLETE
Provider First Name:
ESTRELLA
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1639129307
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1 HAMILTON HEALTH PL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TRENTON
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08690-3542
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
609-631-6899
Provider Business Mailing Address Fax Number:
609-631-6898

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 HAMILTON HEALTH PL
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TRENTON
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08690-3542
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
609-631-6899
Provider Business Practice Location Address Fax Number:
609-631-6898
Provider Enumeration Date:
05/11/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X , with the licence number:  25MA02817500 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: MEP029 . This is a "OXFORD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0439936002 . This is a "CIGNA HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0441914000 . This is a "ANERIHEALTH" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: F01283 . This is a "HEALTHNET" identifier . This identifiers is of the category "OTHER".
  • Identifier: 33086 . This is a "AETNA USHC" identifier . This identifiers is of the category "OTHER".