Healthcare Provider Details

I. General information

NPI: 1003636952
Provider Name (Legal Business Name): DIEGO ETHAN HOCKENBERRY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/15/2024
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 W KIMBERLY AVE STE 220
PLACENTIA CA
92870-6314
US

IV. Provider business mailing address

701 W KIMBERLY AVE STE 220
PLACENTIA CA
92870-6314
US

V. Phone/Fax

Practice location:
  • Phone: 925-222-5643
  • Fax:
Mailing address:
  • Phone: 510-268-8120
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: