Organization
LAKE SIDE MEDICAL CENTER PROFESSIONAL. INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRIAN KEITH GAMBLE M.D. (PRESIDENT)
(818) 985-1221
Entity
Organization
Contact information
Practice address
4300 CRENSHAW BLVD, LOS ANGELES, CA 90008-4902
(323) 298-1668
Mailing address
12115 MAGNOLIA BLVD STE 14, N HOLLYWOOD, CA 91607-2609
(818) 985-1221
(818) 985-1222
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
A76121
CA
293D00000X
Physiological Laboratory
—
—
Other
Enumeration date
05/13/2011
Last updated
08/09/2024
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