Healthcare Provider Details

I. General information

NPI: 1225046535
Provider Name (Legal Business Name): J.A. SANTIESTEBAN, MD, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2006
Last Update Date: 07/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3212 MAIN ST
MUNHALL PA
15120-3230
US

IV. Provider business mailing address

506 ATHENA DR
DELMONT PA
15626-1005
US

V. Phone/Fax

Practice location:
  • Phone: 412-462-1800
  • Fax: 412-462-5006
Mailing address:
  • Phone: 724-468-6869
  • Fax: 724-468-6207

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD039877L
License Number StatePA

VIII. Authorized Official

Name: JOSEPH A SANTIESTEBAN
Title or Position: OWNER
Credential: MD
Phone: 412-462-1800