# LAKESIDE MEDICAL ASSOCIATES, A MEDICAL GROUP, INC.

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Lakeside Community Healthcare Medical Group
- **Organization subpart:** No

## Provider details

- **NPI number:** 1932129434
- **Authorized official:** DR. KERRY E. WEINER M.D. (PRESIDENT)
- **Authorized official phone:** (818) 637-2000

## Contact information

- **Practice address:** 777 FLOWER ST STE A, GLENDALE, CA 91201-3000
- **Practice address phone:** (818) 637-2000
- **Practice address fax:** (818) 242-8761
- **Mailing address:** 777 FLOWER ST STE A, GLENDALE, CA 91201-3000
- **Mailing address phone:** (818) 552-6230
- **Mailing address fax:** (818) 242-8761

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207N00000X | Dermatology Physician | — | NULL | — |
| 207N00000X | Dermatology Physician | — | — | — |
| 207Q00000X | Family Medicine Physician | — | NULL | — |
| 207Q00000X | Family Medicine Physician | — | — | — |
| 207R00000X | Internal Medicine Physician | — | NULL | — |
| 207R00000X | Internal Medicine Physician | — | — | — |
| 207RC0000X | Cardiovascular Disease Physician | — | NULL | — |
| 207RC0000X | Cardiovascular Disease Physician | — | — | — |
| 207RE0101X | Endocrinology, Diabetes & Metabolism Physician | — | NULL | — |
| 207RE0101X | Endocrinology, Diabetes & Metabolism Physician | — | — | — |
| 207RG0100X | Gastroenterology Physician | — | NULL | — |
| 207RG0100X | Gastroenterology Physician | — | — | — |
| 207RR0500X | Rheumatology Physician | — | NULL | — |
| 207RR0500X | Rheumatology Physician | — | — | — |
| 208000000X | Pediatrics Physician | — | NULL | — |
| 208000000X | Pediatrics Physician | — | — | — |
| 2085B0100X | Body Imaging Physician | — | NULL | — |
| 2085B0100X | Body Imaging Physician | — | — | — |
| 208800000X | Urology Physician | — | NULL | — |
| 208800000X | Urology Physician | — | — | — |
| 208D00000X | General Practice Physician | — | NULL | — |
| 208D00000X | General Practice Physician | — | — | — |
| 208M00000X | Hospitalist Physician | — | NULL | Yes |
| 208M00000X | Hospitalist Physician | — | — | Yes |
| 363A00000X | Physician Assistant | — | NULL | — |
| 363A00000X | Physician Assistant | — | — | — |
| 363L00000X | Nurse Practitioner | — | CA | — |
| 363L00000X | Nurse Practitioner | — | NULL | — |
| 363L00000X | Nurse Practitioner | — | — | — |

## Other

- **Enumeration date:** 07/20/2006
- **Last updated:** 05/11/2009

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | GR0068380 | — | CA |
| 05 | — | GR0068381 | — | CA |
| 05 | — | GR0068382 | — | CA |
| 05 | — | GR0068383 | — | CA |
| 05 | — | GR0068384 | — | CA |
| 05 | — | GR0068385 | — | CA |
| 05 | — | GR0068386 | — | CA |
| 05 | — | GR0068387 | — | CA |
| 05 | — | GR0068388 | — | CA |
| 05 | — | GR006838A | — | CA |
| 05 | — | GR006838B | — | CA |