Individual provider Active NPI

Diana Angela Plucker, MD

  • Family Medicine Physician
  • Grand Terrace, CA
National Provider Identifier
1568877629
Registry record updated May 7, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
A147831 Issued in CA
Practice address
11980 Mount Vernon Ave
Grand Terrace, CA 92313-5172
Phone
(909) 864-1097
Fax
(909) 503-1225
NPI assigned
Jun 27, 2014
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 7, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X A147831 CA Primary

Addresses

Primary practice location

11980 Mount Vernon Ave
Grand Terrace, CA 92313-5172

Mailing address

11980 Mount Vernon Ave
Grand Terrace, CA 92313-5172
Phone (909) 864-1097

Other names 1

  • Diana Angela Callari Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA, TX2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20171030001698 CA Practitioner - Family Practice 9133345119 Reassigns benefits to 1 organization
I20200731000652 TX Practitioner - Family Practice 9133345119 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

11555 /2 Potrero Rd
Banning, CA 92220-6946
Phone (951) 849-4761

11980 Mount Vernon Ave
Grand Terrace, CA 92313-5172
Phone (909) 864-1097

23119 Soboba Rd
Soboba Indian Health Clinic
San Jacinto, CA 92583-5517
Phone (951) 654-0803

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
A147831CAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Riverside-San Bernardino County Indian Health, Inc CurrentSince Jul 1, 2020 Accepting new patients
Riverside-San Bernardino County Indian Health, Inc. Current Accepting new patients
Riverside-San Bernardino County Indian Health, Inc. CurrentSince Jul 1, 2020 Accepting new patients

Locations

11980 Mount Vernon Ave
Grand Terrace, CA 92313
Phone (909) 783-8470

23119 Soboba Rd
San Jacinto, CA 92583
Phone (951) 654-0803

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1403827200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1778112000000",
    "number": "1568877629",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11980 MOUNT VERNON AVE",
            "city": "GRAND TERRACE",
            "state": "CA",
            "postal_code": "923135172",
            "telephone_number": "909-864-1097",
            "fax_number": "909-503-1229"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11980 MOUNT VERNON AVE",
            "city": "GRAND TERRACE",
            "state": "CA",
            "postal_code": "923135172",
            "telephone_number": "909-864-1097",
            "fax_number": "909-503-1225"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PLUCKER",
        "first_name": "DIANA",
        "middle_name": "ANGELA",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-06-27",
        "last_updated": "2026-05-07",
        "certification_date": "2026-05-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "A147831",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "DIANA",
            "last_name": "CALLARI",
            "middle_name": "ANGELA",
            "credential": "MD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Grand Terrace, CA

Sources for this page

Verify at the official NPI Registry.