MEDICARE: DR. JACKYLINE SANCHEZ PRESTOSA MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician	MDR7492	HI
2	207V00000X	Obstetrics & Gynecology Physician	MD-22593	HI

General Provider Information

NPI Number	:	1003305749
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JACKYLINE SANCHEZ PRESTOSA MD

Provider Business Mailing Address
First Line	:	91-6390 KAPOLEI PKWY STE 200
Second Line	:
City	:	EWA BEACH
State	:	HI
Zip	:	96706-6380
Country	:	US
Telephone Number	:	808-691-8200
Fax Number	:

Provider Business Practice Location Address
First Line	:	91-6390 KAPOLEI PKWY STE 200
Second Line	:
City	:	EWA BEACH
State	:	HI
Zip	:	96706-6380
Country	:	US
Telephone Number	:	808-691-8200
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/08/2018
Last Update Date	:	09/03/2022

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