Healthcare Provider Details

I. General information

NPI: 1184629131
Provider Name (Legal Business Name): RICHARD LLOYD MALINICK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2005
Last Update Date: 05/01/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1125 VIA VERDE
SAN DIMAS CA
91773-4400
US

IV. Provider business mailing address

1125 VIA VERDE
SAN DIMAS CA
91773-4400
US

V. Phone/Fax

Practice location:
  • Phone: 909-592-8170
  • Fax: 909-599-0750
Mailing address:
  • Phone: 909-592-8170
  • Fax: 909-599-0750

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberG52882
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: