Individual
JON P LAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
12601 GARDEN GROVE BLVD, GARDEN GROVE, CA 92843-1908
(714) 741-2765
(714) 590-2490
Mailing address
PO BOX 10076, VAN NUYS, CA 91410-0076
(805) 578-8300
(805) 578-8950
Taxonomy
Speciality
Code
Description
License number
State
207ZC0500X
Cytopathology Physician
Primary
A84772
CA
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
A84772
CA
Other
Enumeration date
07/08/2006
Last updated
09/11/2025
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