Editha Pascual Poblete

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

47993 Issued in CA

Practice address

11631 Victory Blvd. Ste. 102
North Hollywood, CA 91606

Phone

(818) 766-3660

Fax

(818) 766-1867

NPI assigned

Oct 2, 2006

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Fernandez-Poblete Dental Corporation

  dba Victory Dental Care

  • General Practice Dentistry
  • North Hollywood, CA
  • NPI 1598806614
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1159747200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1346333861",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11631 VICTORY BLVD. STE. 102",
            "city": "NORTH HOLLYWOOD",
            "state": "CA",
            "postal_code": "91606",
            "telephone_number": "818-766-3660",
            "fax_number": "818-766-1867"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11631 VICTORY BLVD. STE. 102",
            "city": "NORTH HOLLYWOOD",
            "state": "CA",
            "postal_code": "91606",
            "telephone_number": "818-766-3660",
            "fax_number": "818-766-1867"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "POBLETE",
        "first_name": "EDITHA",
        "middle_name": "PASCUAL",
        "name_prefix": "Dr.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-02",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "47993",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DENTI-CAL",
            "identifier": "G92361-01",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Cecilia Plascencia
• Candus Lee Platt
• Pluto Home Health Care, Inc
• Anastasia Plyugina
• Pobeda Services, Inc (BEST Community Based Adult Services)
• Laura Poghosian, DDS
• Andrew James Pokorny
• Ara A Poladian, M.D., F.A.C.O.G.
• Jeffry Pollard Jr.
• Enjil Poloss, MS

• General Practice Dentistry in North Hollywood, CA
• Providers in North Hollywood, CA by specialty
• General Practice Dentistry in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.