Provider Demographics
NPI:1275707622
Name:DERIC LORDS D P M A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:DERIC LORDS D P M A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:ANDERSON
Authorized Official - Last Name:LORDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-996-7601
Mailing Address - Street 1:1310 N KRAEMER BLVD
Mailing Address - Street 2:
Mailing Address - City:PLACENTIA
Mailing Address - State:CA
Mailing Address - Zip Code:92870-3401
Mailing Address - Country:US
Mailing Address - Phone:714-996-7601
Mailing Address - Fax:714-996-0745
Practice Address - Street 1:1310 N KRAEMER BLVD
Practice Address - Street 2:
Practice Address - City:PLACENTIA
Practice Address - State:CA
Practice Address - Zip Code:92870-3401
Practice Address - Country:US
Practice Address - Phone:714-996-7601
Practice Address - Fax:714-996-0745
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-16
Last Update Date:2012-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE2783213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000E2783Medicaid
CAE2783OtherMEDICARE ID
CADM404AMedicare PIN
CAT19233Medicare UPIN
CA0221730001Medicare NSC