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
DR. KERRY E. WEINER M.D. (PRESIDENT)
(818) 637-2000
Entity
Organization
Contact information
Practice address
222 W EULALIA ST, SUITE 200, GLENDALE, CA 91204-2849
(818) 291-4010
(818) 291-4058
Mailing address
777 FLOWER ST, SUITE A, GLENDALE, CA 91201-3015
(818) 637-2000
(818) 242-8761
Taxonomy
Speciality
Code
Description
License number
State
207RE0101X
Endocrinology, Diabetes & Metabolism Physician
—
—
207RG0100X
Gastroenterology Physician
—
—
207RR0500X
Rheumatology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GR0068387
—
CA
Enumeration date
08/29/2006
Last updated
05/12/2009
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