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General NPI Number Information
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NPI Number | 1952086191
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Entity Type | Individual
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Provider Name | ALEXANDER PIO POBLETE
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Gender | Male
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Dates
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Enumeration Date | 06/15/2023
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Last Update Date | 07/06/2023
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Provider Practice Location Address
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Address Line | 3300 GALLOWS RD
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City | FALLS CHURCH
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State | VA
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Zip | 22042-3307
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Country | US
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Telephone | 793-776-3582
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Fax |
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Provider Business Mailing Address
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Address Line | 416 WOODLAWN RD
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City | BALTIMORE
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State | MD
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Zip | 21210-2311
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Country | US
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Telephone | 410-916-3452
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number | 0116038140
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License Number State | VA
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