Provider Demographics
NPI:1639129307
Name:POBLETE, ESTRELLA M (MD)
Entity Type:Individual
Prefix:
First Name:ESTRELLA
Middle Name:M
Last Name: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 1:1 HAMILTON HEALTH PL
Mailing Address - Street 2:
Mailing Address - City:TRENTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08690-3542
Mailing Address - Country:US
Mailing Address - Phone:609-631-6899
Mailing Address - Fax:609-631-6898
Practice Address - Street 1:1 HAMILTON HEALTH PL
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:NJ
Practice Address - Zip Code:08690-3542
Practice Address - Country:US
Practice Address - Phone:609-631-6899
Practice Address - Fax:609-631-6898
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA02817500207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEP029OtherOXFORD
0439936002OtherCIGNA HEALTHCARE
NJ0441914000OtherANERIHEALTH
F01283OtherHEALTHNET
33086OtherAETNA USHC
C60709Medicare UPIN
33086OtherAETNA USHC