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Organization
PODIATRY GROUP SOUTH A PROFFESSIONAL PODIATRY CORPORATION
Active
Organization
PODIATRY GROUP SOUTH A PROFFESSIONAL PODIATRY CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
IRA A DIAMOND DPM (SOLE OWNER)
(909) 599-0981
Entity
Organization
Contact information
Practice address
425 W BONITA AVE STE 110, SAN DIMAS, CA 91773-2543
(909) 599-0981
(909) 592-0738
Mailing address
425 W BONITA AVE STE 110, SAN DIMAS, CA 91773-2543
(909) 599-0981
(909) 592-0738
Taxonomy
Speciality
Code
Description
License number
State
213EP0504X
Public Medicine Podiatrist
Primary
E2340
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GRE000821
—
CA
Enumeration date
01/22/2007
Last updated
03/11/2014
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