Provider Demographics
NPI:1205533270
Name:DIMGBA, CHIBUIKEM SAMUEL (RD)
Entity type:Individual
Prefix:
First Name:CHIBUIKEM
Middle Name:SAMUEL
Last Name:DIMGBA
Suffix:
Gender:M
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2338 TEXAS ST # 3D
Mailing Address - Street 2:
Mailing Address - City:PECOS
Mailing Address - State:TX
Mailing Address - Zip Code:79772-7302
Mailing Address - Country:US
Mailing Address - Phone:346-219-4901
Mailing Address - Fax:
Practice Address - Street 1:2349 MEDICAL DRIVE
Practice Address - Street 2:
Practice Address - City:PECOS
Practice Address - State:TX
Practice Address - Zip Code:79772
Practice Address - Country:US
Practice Address - Phone:432-447-3551
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-10
Last Update Date:2023-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT86082133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered