Provider Demographics
NPI:1750129912
Name:OGODO, DIAMOND (DNP)
Entity type:Individual
Prefix:
First Name:DIAMOND
Middle Name:
Last Name:OGODO
Suffix:
Gender:M
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4545 GALISTEO LOOP
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88011-4301
Mailing Address - Country:US
Mailing Address - Phone:813-833-5250
Mailing Address - Fax:
Practice Address - Street 1:760 N MOTEL BLVD
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88007-4169
Practice Address - Country:US
Practice Address - Phone:575-527-7975
Practice Address - Fax:575-674-2861
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-19
Last Update Date:2025-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM53909163WP0808X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health