Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2084N0400X | Neurologist | 25MA10978500 | NJ |
Y | 2084N0400X | Neurologist | A123997 | CA |
NPI | 1033400676 |
---|---|
Provider Name | Roy Armand Poblete |
First Address | Los Angeles, CA 90031-0309 |
Second Address | Los Angeles, CA 90033 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/05/2011 |
Last Update Date | 17/12/2021 |