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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
12660 RIVERSIDE DR, SUITE 310/320, NORTH HOLLYWOOD, CA 91607-3429
(818) 755-0391
(818) 753-8165
Mailing address
777 FLOWER ST, SUITE A, GLENDALE, CA 91201-3015
(818) 637-2000
(818) 242-8761
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
CA
207R00000X
Internal Medicine Physician
—
CA
208000000X
Pediatrics Physician
—
CA
363L00000X
Nurse Practitioner
—
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GR0068380
—
CA
Enumeration date
07/08/2005
Last updated
05/06/2009
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