Healthcare Provider Details

I. General information

NPI: 1255262788
Provider Name (Legal Business Name): ESCONDIDO PODIATRY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2026
Last Update Date: 05/26/2026
Certification Date: 05/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

260 W CREST ST STE A
ESCONDIDO CA
92025-1716
US

IV. Provider business mailing address

260 W CREST ST STE A
ESCONDIDO CA
92025-1716
US

V. Phone/Fax

Practice location:
  • Phone: 858-304-7690
  • Fax:
Mailing address:
  • Phone: 858-304-7690
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP1100X
TaxonomyPodiatric Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LORA D YEAGER-SMITH
Title or Position: PODIATRIST
Credential: DPM
Phone: 951-396-1538