Basic Information
| Provider Information | |||||||||
| NPI: | 1568877629 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PLUCKER | ||||||||
| FirstName: | DIANA | ||||||||
| MiddleName: | ANGELA | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | CALLARI | ||||||||
| OtherFirstName: | DIANA | ||||||||
| OtherMiddleName: | ANGELA | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | MD | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 18601 VALLEY BLVD | ||||||||
| Address2: | |||||||||
| City: | BLOOMINGTON | ||||||||
| State: | CA | ||||||||
| PostalCode: | 923161831 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9095467520 | ||||||||
| FaxNumber: | 9098775468 | ||||||||
| Practice Location | |||||||||
| Address1: | 18601 VALLEY BLVD | ||||||||
| Address2: | |||||||||
| City: | BLOOMINGTON | ||||||||
| State: | CA | ||||||||
| PostalCode: | 923161831 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9095467520 | ||||||||
| FaxNumber: | 9098775468 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/27/2014 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 94-08438 | KS | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.