Individual
DR. JAMES GUIDO DISTEFANO JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
947 MARINA VILLAGE PKWY, ALAMEDA, CA 94501-1048
(510) 522-6637
Mailing address
947 MARINA VILLAGE PKWY, ALAMEDA, CA 94501-1048
(510) 522-6637
Taxonomy
Speciality
Code
Description
License number
State
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
Primary
A103423
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1427081165
—
CA
Enumeration date
07/21/2010
Last updated
08/28/2013
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