# JENNETTE BERGSTEDT MD LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1427174549
- **Authorized official:** DR. JENNETTE SEPULVADO BERGSTEDT MD (OWNER)
- **Authorized official phone:** (337) 474-2933

## Contact information

- **Practice address:** 4150 NELSON RD STE E1, LAKE CHARLES, LA 70605-4133
- **Practice address phone:** (337) 474-2933
- **Practice address fax:** (337) 474-5283
- **Mailing address:** 4150 NELSON RD STE E1, LAKE CHARLES, LA 70605-4133
- **Mailing address phone:** (337) 474-2933
- **Mailing address fax:** (337) 474-5283

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM2500X | Medical Specialty Clinic/Center | MD.021307 | LA | Yes |

## Other

- **Enumeration date:** 03/21/2007
- **Last updated:** 06/26/2008