Provider Demographics
NPI:1063663359
Name:DIMALIBOT, RICCA (MD)
Entity Type:Individual
Prefix:
First Name:RICCA
Middle Name:
Last Name:DIMALIBOT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:RICCA
Other - Middle Name:
Other - Last Name:DIMALIBOT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:919 HIDDEN RDG
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75038-3813
Mailing Address - Country:US
Mailing Address - Phone:469-282-2713
Mailing Address - Fax:469-282-0996
Practice Address - Street 1:2401 TERMINI ST
Practice Address - Street 2:SUITE 100-D
Practice Address - City:DICKINSON
Practice Address - State:TX
Practice Address - Zip Code:77539-4995
Practice Address - Country:US
Practice Address - Phone:713-803-1830
Practice Address - Fax:281-534-3492
Is Sole Proprietor?:No
Enumeration Date:2008-10-05
Last Update Date:2017-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM9975207Q00000X
CAA98250207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX203519801Medicaid
8L12358Medicare UPIN