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General NPI Number Information
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NPI Number | 1275707622
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Entity Type | Organization
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Legal Business Name | DERIC LORDS D P M A PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 04/16/2008
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Last Update Date | 01/25/2012
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Provider Practice Location Address
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Address Line | 1310 N KRAEMER BLVD
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City | PLACENTIA
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State | CA
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Zip | 92870-3401
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Country | US
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Telephone | 714-996-7601
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Fax | 714-996-0745
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Provider Business Mailing Address
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Address Line | 1310 N KRAEMER BLVD
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City | PLACENTIA
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State | CA
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Zip | 92870-3401
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Country | US
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Telephone | 714-996-7601
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Fax | 714-996-0745
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. DEBORAH ANDERSON LORDS
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Credential |
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Telephone | 714-996-7601
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | E2783
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License Number State | CA
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