Provider Demographics
NPI:1568877629
Name:PLUCKER, DIANA ANGELA (MD)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:ANGELA
Last Name:PLUCKER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:DIANA
Other - Middle Name:ANGELA
Other - Last Name:CALLARI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:18601 VALLEY BLVD
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:CA
Mailing Address - Zip Code:92316-1831
Mailing Address - Country:US
Mailing Address - Phone:909-546-7520
Mailing Address - Fax:909-877-5468
Practice Address - Street 1:18601 VALLEY BLVD
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:CA
Practice Address - Zip Code:92316-1831
Practice Address - Country:US
Practice Address - Phone:909-546-7520
Practice Address - Fax:909-877-5468
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-27
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS94-08438207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine