Individual
MR. ANTHONY M LAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RN
Contact information
Practice address
3853 ROSECRANS ST, SAN DIEGO, CA 92110-3115
(619) 692-8232
Mailing address
3853 ROSECRANS ST, SAN DIEGO, CA 92110-3115
(619) 692-8232
Taxonomy
Speciality
Code
Description
License number
State
163WM0705X
Medical-Surgical Registered Nurse
245932
AZ
163WM0705X
Medical-Surgical Registered Nurse
95281724
CA
163WP0809X
Adult Psychiatric/Mental Health Registered Nurse
Primary
95281724
CA
Other
Enumeration date
05/11/2022
Last updated
05/17/2022
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