Healthcare Provider Details

I. General information

NPI: 1649564220
Provider Name (Legal Business Name): ROBERT LORDS DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2011
Last Update Date: 09/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 E YORBA LINDA BLVD STE 7
PLACENTIA CA
92870-3006
US

IV. Provider business mailing address

921 BONNIE WAY
BREA CA
92821-2012
US

V. Phone/Fax

Practice location:
  • Phone: 714-996-7601
  • Fax: 714-996-0745
Mailing address:
  • Phone: 714-745-6353
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberE5125
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: