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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
DR. KERRY E. WEINER M.D. (PRESIDENT)
(818) 637-2000
Entity
Organization
Contact information
Practice address
101 S FIRST STREET, SUITE 1800, BURBANK, CA 91502-1938
(818) 558-7252
(818) 558-7312
Mailing address
777 FLOWER ST STE A, GLENDALE, CA 91201-3000
(818) 637-2000
(818) 242-8761
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GPT001160
—
CA
Enumeration date
08/01/2006
Last updated
05/11/2009
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