Organization
JLS MEDICAL ENTERPRISES PSC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOANNA LOURDES SANTIESTEBAN MD (OFFICER)
(606) 886-1162
Entity
Organization
Contact information
Practice address
400 UNIVERSITY DR, SUITE 201B, PRESTONSBURG, KY 41653-1080
(606) 886-4277
Mailing address
400 UNIVERSITY DR, SUITE 201B, PRESTONSBURG, KY 41653-1080
(606) 886-4277
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
—
—
363A00000X
Physician Assistant
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100175380
—
KY
Enumeration date
04/11/2011
Last updated
12/27/2011
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