Provider Demographics
NPI:1700648391
Name:PEDIDA, ARIANE DIOLA
Entity type:Individual
Prefix:
First Name:ARIANE
Middle Name:DIOLA
Last Name:PEDIDA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7950 N HORSESHOE BEND RD STE 106
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83714-3809
Mailing Address - Country:US
Mailing Address - Phone:208-813-4855
Mailing Address - Fax:
Practice Address - Street 1:7950 N HORSESHOE BEND RD STE 106
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83714-3809
Practice Address - Country:US
Practice Address - Phone:208-813-4855
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-29
Last Update Date:2025-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDMAS-4434225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty