Healthcare Provider Details

I. General information

NPI: 1710816350
Provider Name (Legal Business Name): DIAGNOVERA INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2026
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1325 E COOLEY DR STE 109
COLTON CA
92324-3966
US

IV. Provider business mailing address

1325 E COOLEY DR STE 109
COLTON CA
92324-3966
US

V. Phone/Fax

Practice location:
  • Phone: 559-250-3393
  • Fax:
Mailing address:
  • Phone: 559-250-3393
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MEHRDAD GHAHREMANI-GHAJAR
Title or Position: PRESIDENT
Credential: DO
Phone: 559-250-3393