Provider Demographics
NPI:1093994113
Name:LORIE S. ROBINSON
Entity Type:Organization
Organization Name:LORIE S. ROBINSON
Other - Org Name:AGOURA PODIATRY GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LORIE
Authorized Official - Middle Name:S
Authorized Official - Last Name:ROBINSON
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:818-991-6337
Mailing Address - Street 1:28240 AGOURA RD
Mailing Address - Street 2:SUITE101
Mailing Address - City:AGOURA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91301-2485
Mailing Address - Country:US
Mailing Address - Phone:818-991-6337
Mailing Address - Fax:818-879-1891
Practice Address - Street 1:28240 AGOURA RD
Practice Address - Street 2:SUITE101
Practice Address - City:AGOURA HILLS
Practice Address - State:CA
Practice Address - Zip Code:91301-2485
Practice Address - Country:US
Practice Address - Phone:818-991-6337
Practice Address - Fax:818-879-1891
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-25
Last Update Date:2007-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWE7178Medicare PIN