Organization
JENNETTE BERGSTEDT MD LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JENNETTE SEPULVADO BERGSTEDT MD (OWNER)
(337) 474-2933
Entity
Organization
Contact information
Practice address
4150 NELSON RD STE E1, LAKE CHARLES, LA 70605-4133
(337) 474-2933
(337) 474-5283
Mailing address
4150 NELSON RD STE E1, LAKE CHARLES, LA 70605-4133
(337) 474-2933
(337) 474-5283
Taxonomy
Speciality
Code
Description
License number
State
261QM2500X
Medical Specialty Clinic/Center
Primary
MD.021307
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1655724
—
LA
Enumeration date
03/21/2007
Last updated
06/26/2008
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