Healthcare Provider Details

I. General information

NPI: 1669988655
Provider Name (Legal Business Name): HAPPY FEET PODIATRY P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/28/2017
Last Update Date: 12/28/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 E YORBA LINDA BLVD STE 6
PLACENTIA CA
92870-3006
US

IV. Provider business mailing address

601 E YORBA LINDA BLVD STE 6
PLACENTIA CA
92870-3006
US

V. Phone/Fax

Practice location:
  • Phone: 714-996-7601
  • Fax: 714-996-0745
Mailing address:
  • Phone: 714-996-7601
  • Fax: 714-996-0745

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License NumberE5125
License Number StateCA

VIII. Authorized Official

Name: DR. ROBERT GREGORY LORDS
Title or Position: PRESIDENT
Credential: DPM
Phone: 714-996-7601