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
191 S BUENA VISTA ST, SUITE 420, BURBANK, CA 91505-4554
(818) 557-7399
(818) 848-1543
Mailing address
777 FLOWER ST, SUITE A, GLENDALE, CA 91201-3015
(818) 637-2000
(818) 242-8761
Taxonomy
Speciality
Code
Description
License number
State
207RP1001X
Pulmonary Disease Physician
—
—
207RR0500X
Rheumatology Physician
Primary
—
—
208600000X
Surgery Physician
—
—
363L00000X
Nurse Practitioner
—
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GR0068386
—
CA
Enumeration date
07/07/2005
Last updated
03/25/2009
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