Provider Demographics
NPI:1003305749
Name:PRESTOSA, JACKYLINE SANCHEZ (MD)
Entity Type:Individual
Prefix:DR
First Name:JACKYLINE
Middle Name:SANCHEZ
Last Name:PRESTOSA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:91-6390 KAPOLEI PKWY STE 200
Mailing Address - Street 2:
Mailing Address - City:EWA BEACH
Mailing Address - State:HI
Mailing Address - Zip Code:96706-6380
Mailing Address - Country:US
Mailing Address - Phone:808-691-8200
Mailing Address - Fax:
Practice Address - Street 1:91-6390 KAPOLEI PKWY STE 200
Practice Address - Street 2:
Practice Address - City:EWA BEACH
Practice Address - State:HI
Practice Address - Zip Code:96706-6380
Practice Address - Country:US
Practice Address - Phone:808-691-8200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-08
Last Update Date:2022-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMDR7492207V00000X
HIMD-22593207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology