Individual
PAULA A LIDESTRI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1150 N INDIAN CANYON DR, PALM SPRINGS, CA 92262
(760) 323-6511
(760) 323-6538
Mailing address
16219 DEER RUN ROAD, WATERTOWN, NY 13601
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
225974
NY
208100000X
Physical Medicine & Rehabilitation Physician
35086210
OH
208100000X
Physical Medicine & Rehabilitation Physician
Primary
A110395
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2572603
—
OH
Enumeration date
10/03/2006
Last updated
07/23/2018
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