Provider Demographics
NPI:1407128119
Name:RAMOS-POBLETE, JADE (MD)
Entity Type:Individual
Prefix:
First Name:JADE
Middle Name:
Last Name:RAMOS-POBLETE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 EL CAMINO REAL
Mailing Address - Street 2:
Mailing Address - City:SAN BRUNO
Mailing Address - State:CA
Mailing Address - Zip Code:94066-3009
Mailing Address - Country:US
Mailing Address - Phone:650-742-2100
Mailing Address - Fax:
Practice Address - Street 1:901 EL CAMINO REAL
Practice Address - Street 2:
Practice Address - City:SAN BRUNO
Practice Address - State:CA
Practice Address - Zip Code:94066-3009
Practice Address - Country:US
Practice Address - Phone:650-742-2100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-27
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA118032207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine