Provider Demographics
NPI:1750423489
Name:OCHUKO G DIAMREYAN,MD. INC
Entity type:Organization
Organization Name:OCHUKO G DIAMREYAN,MD. INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:OCHUKO
Authorized Official - Middle Name:GREGSON
Authorized Official - Last Name:DIAMREYAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:909-886-7475
Mailing Address - Street 1:2380 NORTH SIERRA WAY
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92405-3546
Mailing Address - Country:US
Mailing Address - Phone:909-886-7475
Mailing Address - Fax:909-886-7305
Practice Address - Street 1:2380 NORTH SIERRA WAY
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92405-3546
Practice Address - Country:US
Practice Address - Phone:909-886-7475
Practice Address - Fax:909-886-7305
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-12
Last Update Date:2009-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA664322084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A664321Medicare ID - Type Unspecified
F91389Medicare UPIN