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Organization
LAKE SIDE DIAGNOSTICS CENTER, INC.
Active
Organization
LAKE SIDE DIAGNOSTICS CENTER, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
YEVGENY KANZBURG (PRESIDENT)
(818) 985-1999
Entity
Organization
Contact information
Practice address
6908 VARNA AVE, VALLEY GLEN, CA 91405-4358
(818) 985-1999
(818) 985-1222
Mailing address
6908 VARNA AVE, VALLEY GLEN, CA 91405-4358
(818) 985-1999
(818) 985-1222
Taxonomy
Speciality
Code
Description
License number
State
2471S1302X
Sonography Radiologic Technologist
—
CA
261QR0208X
Mobile Radiology Clinic/Center
Primary
—
CA
261QR0208X
Mobile Radiology Clinic/Center
—
—
293D00000X
Physiological Laboratory
—
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3311838
—
CA
Enumeration date
10/19/2007
Last updated
10/26/2022
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