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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 MD (PRESIDENT)
(818) 637-2000
Entity
Organization
Contact information
Practice address
4955 VAN NUYS BLVD, SUITE 308, SHERMAN OAKS, CA 91403-1811
(818) 907-5088
(818) 907-5891
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
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1104087774
—
CA
Enumeration date
06/17/2008
Last updated
05/06/2009
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