Individual
MR. MICHAEL JOSEPH DISTEFANO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
4650 PALM AVE, SAN DIEGO, CA 92154-8404
(619) 662-5277
Mailing address
4650 PALM AVE, SAN DIEGO, CA 92154-8404
(619) 662-5277
Taxonomy
Speciality
Code
Description
License number
State
2251X0800X
Orthopedic Physical Therapist
012611
NY
2251X0800X
Orthopedic Physical Therapist
Primary
41475
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
ANC890
OXFORD
NY
01
—
Q88121
BCBS
NY
Enumeration date
09/30/2005
Last updated
11/19/2015
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