Healthcare Provider Details

I. General information

NPI: 1568877629
Provider Name (Legal Business Name): DIANA ANGELA PLUCKER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: DIANA ANGELA CALLARI MD

II. Dates (important events)

Enumeration Date: 06/27/2014
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18601 VALLEY BLVD
BLOOMINGTON CA
92316-1831
US

IV. Provider business mailing address

18601 VALLEY BLVD
BLOOMINGTON CA
92316-1831
US

V. Phone/Fax

Practice location:
  • Phone: 909-546-7520
  • Fax: 909-877-5468
Mailing address:
  • Phone: 909-546-7520
  • Fax: 909-877-5468

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number94-08438
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: