Healthcare Provider Details

I. General information

NPI: 1841297488
Provider Name (Legal Business Name): DERIC LORDS DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/28/2005
Last Update Date: 07/18/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1310 N KRAEMER BLVD
PLACENTIA CA
92870-3401
US

IV. Provider business mailing address

1310 N KRAEMER BLVD
PLACENTIA CA
92870-3401
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 Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberE2783
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: