Organization
LAKESIDE MEDICAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ISAIAH TANNACI (OWNER)
(775) 265-4072
Entity
Organization
Contact information
Practice address
1482 IRENE CT, GARDNERVILLE, NV 89460-8205
(775) 265-4072
(775) 265-4062
Mailing address
1482 IRENE CT, GARDNERVILLE, NV 89460-8205
(775) 265-4072
(775) 265-4062
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Enumeration date
06/02/2008
Last updated
06/02/2008
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