Provider Demographics
NPI:1184629131
Name:MALINICK, RICHARD LLOYD (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:LLOYD
Last Name:MALINICK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1125 VIA VERDE
Mailing Address - Street 2:
Mailing Address - City:SAN DIMAS
Mailing Address - State:CA
Mailing Address - Zip Code:91773-4400
Mailing Address - Country:US
Mailing Address - Phone:909-592-8170
Mailing Address - Fax:909-599-0750
Practice Address - Street 1:1125 VIA VERDE
Practice Address - Street 2:
Practice Address - City:SAN DIMAS
Practice Address - State:CA
Practice Address - Zip Code:91773-4400
Practice Address - Country:US
Practice Address - Phone:909-592-8170
Practice Address - Fax:909-599-0750
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-16
Last Update Date:2014-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG52882207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G528821Medicaid
CAA52376Medicare UPIN
CA00G528821Medicaid