# LAKESIDE SURGERY CENTER LP

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1760423297
- **Authorized official:** LISA R DEBRUNO (ADMINISTRATOR)
- **Authorized official phone:** (818) 637-7766

## Contact information

- **Practice address:** 5700 SAN FERNANDO RD, GLENDALE, CA 91202-2104
- **Practice address phone:** (818) 637-7766
- **Practice address fax:** (818) 956-1706
- **Mailing address:** 5700 SAN FERNANDO RD, GLENDALE, CA 91202-2104
- **Mailing address phone:** (818) 637-7766
- **Mailing address fax:** (818) 956-1706

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QA1903X | Ambulatory Surgical Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 06/08/2006
- **Last updated:** 12/13/2007