Provider Demographics
NPI:1760256879
Name:DIAMONDCREST MEDICAL CENTER
Entity Type:Organization
Organization Name:DIAMONDCREST MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ARINOLA
Authorized Official - Middle Name:
Authorized Official - Last Name:ODUMUSI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:469-481-6660
Mailing Address - Street 1:291 S PRESTON RD STE 1120
Mailing Address - Street 2:
Mailing Address - City:PROSPER
Mailing Address - State:TX
Mailing Address - Zip Code:75078-1913
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:291 S PRESTON RD STE 1120
Practice Address - Street 2:
Practice Address - City:PROSPER
Practice Address - State:TX
Practice Address - Zip Code:75078-1913
Practice Address - Country:US
Practice Address - Phone:469-481-6660
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-09
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty