Provider Demographics
NPI:1588981120
Name:SMITH-BURKE PODIATRY
Entity type:Organization
Organization Name:SMITH-BURKE PODIATRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:MARILUCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-991-3333
Mailing Address - Street 1:1761 W ROMNEYA DR
Mailing Address - Street 2:SUITE E
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92801-1816
Mailing Address - Country:US
Mailing Address - Phone:714-991-3333
Mailing Address - Fax:
Practice Address - Street 1:14642 NEWPORT AVE
Practice Address - Street 2:SUITE 105
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-6057
Practice Address - Country:US
Practice Address - Phone:714-505-5000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-21
Last Update Date:2010-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE2588213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty