Provider Demographics
NPI:1801994942
Name:POBLETE, EVANGELINA PASEUAL (MD)
Entity type:Individual
Prefix:DR
First Name:EVANGELINA
Middle Name:PASEUAL
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 1:3AA JOSEPH & ROSENDAHL
Mailing Address - Street 2:
Mailing Address - City:ST. THOMAS
Mailing Address - State:VI
Mailing Address - Zip Code:00802
Mailing Address - Country:US
Mailing Address - Phone:340-776-1021
Mailing Address - Fax:
Practice Address - Street 1:9TH STREET SUGAR ESTATE
Practice Address - Street 2:STE.1B
Practice Address - City:ST. THOMAS
Practice Address - State:VI
Practice Address - Zip Code:00801
Practice Address - Country:US
Practice Address - Phone:340-776-3389
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VI735208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
VIBP1281550OtherPEDIATRICS