Provider Demographics
NPI:1063944759
Name:POBLETE, JOBERT BALLESTEROS (MD)
Entity type:Individual
Prefix:
First Name:JOBERT
Middle Name:BALLESTEROS
Last Name:POBLETE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:5757 WILSHIRE BLVD STE 448
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90036-3658
Mailing Address - Country:US
Mailing Address - Phone:424-277-2899
Mailing Address - Fax:424-277-2899
Practice Address - Street 1:5757 WILSHIRE BLVD STE 448
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90036-3658
Practice Address - Country:US
Practice Address - Phone:424-277-2899
Practice Address - Fax:424-277-2899
Is Sole Proprietor?:No
Enumeration Date:2017-03-31
Last Update Date:2024-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA1615882084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry