Organization
JEFFREY P. LAKE, M.D., INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JEFFREY LAKE M.D. (PHYSICIAN/OWNER)
(818) 387-8725
Entity
Organization
Contact information
Practice address
16311 VENTURA BLVD, SUITE 505, ENCINO, CA 91436-2124
(818) 387-8725
Mailing address
16311 VENTURA BLVD, SUITE 505, ENCINO, CA 91436-2124
(818) 387-8725
Taxonomy
Speciality
Code
Description
License number
State
208C00000X
Colon & Rectal Surgery Physician
Primary
A73315
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
WA73315A
MEDICARE PPIN
—
Enumeration date
09/20/2010
Last updated
11/16/2010
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