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Organization
LAKESIDE MEDICAL ASSOCIATES, A MEDICAL GROUP, INC.
Active
Organization
LAKESIDE MEDICAL ASSOCIATES, A MEDICAL GROUP, INC.
Active
Other names
Lakeside Community Healthcare Medical Group
Organization subpart
No
Provider details
NPI number
Authorized official
KERRY E. WEINER M.D. (PRESIDENT)
(818) 637-2000
Entity
Organization
Contact information
Practice address
3605 ALAMO ST, SUITE 100, SIMI VALLEY, CA 93063-2186
(805) 522-6577
(805) 522-7030
Mailing address
777 FLOWER STREET, SUITE A, GLENDALE, CA 91201-3000
(818) 637-2000
(818) 242-8761
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
207R00000X
Internal Medicine Physician
—
—
208000000X
Pediatrics Physician
—
—
208D00000X
General Practice Physician
—
—
363A00000X
Physician Assistant
—
—
Other
Enumeration date
07/21/2008
Last updated
09/04/2009
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