Provider Demographics
NPI:1669270500
Name:POBLETE, EDRINA
Entity type:Individual
Prefix:
First Name:EDRINA
Middle Name:
Last Name:POBLETE
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14989 BLUE GRASS DR # 2250
Mailing Address - Street 2:
Mailing Address - City:HELENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:92342-7727
Mailing Address - Country:US
Mailing Address - Phone:760-994-2123
Mailing Address - Fax:
Practice Address - Street 1:14989 BLUE GRASS DR # 2250
Practice Address - Street 2:
Practice Address - City:HELENDALE
Practice Address - State:CA
Practice Address - Zip Code:92342-7727
Practice Address - Country:US
Practice Address - Phone:760-994-2123
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-06
Last Update Date:2025-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes342000000XTransportation ServicesTransportation Network Company