Organization
LAKESIDE MEDICAL ASSOCIATES, A MEDICAL GROUP, INC.
Active
Organization
LAKESIDE MEDICAL ASSOCIATES, A MEDICAL GROUP, INC.
Active
Other names
Lakeside Community Healthcare Medical Group
Organization subpart
No
Provider details
NPI number
Authorized official
KERRY E. WEINER M.D. (PRESIDENT)
(818) 637-2000
Entity
Organization
Contact information
Practice address
12660 RIVERSIDE DR, SUITE 225, N HOLLYWOOD, CA 91607-3429
(818) 755-0265
(818) 753-9074
Mailing address
777 FLOWER ST STE A, GLENDALE, CA 91201-3000
(818) 637-2000
(818) 242-8761
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
—
—
207Q00000X
Family Medicine Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GR0068384
—
CA
Enumeration date
09/11/2007
Last updated
05/06/2009
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