Provider Demographics
NPI:1225389075
Name:CLOSAS, GARRY POBLETE (CNS, ACNP)
Entity Type:Individual
Prefix:MR
First Name:GARRY
Middle Name:POBLETE
Last Name:CLOSAS
Suffix:
Gender:M
Credentials:CNS, ACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:USS CARL VINSON
Mailing Address - Street 2:MEDICAL DEPARTMENT
Mailing Address - City:FPO
Mailing Address - State:AP
Mailing Address - Zip Code:96629-2840
Mailing Address - Country:US
Mailing Address - Phone:619-545-3616
Mailing Address - Fax:
Practice Address - Street 1:USS CARL VINSON
Practice Address - Street 2:MEDICAL DEPARTMENT
Practice Address - City:FPO
Practice Address - State:AP
Practice Address - Zip Code:96629-2840
Practice Address - Country:US
Practice Address - Phone:619-545-3616
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-19
Last Update Date:2012-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19530363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care