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
777 FLOWER ST STE A, GLENDALE, CA 91201-3000
(818) 637-2000
(818) 242-8761
Mailing address
777 FLOWER ST STE A, GLENDALE, CA 91201-3000
(818) 552-6230
(818) 242-8761
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
—
—
207Q00000X
Family Medicine Physician
—
—
207R00000X
Internal Medicine Physician
—
—
207RC0000X
Cardiovascular Disease Physician
—
—
207RE0101X
Endocrinology, Diabetes & Metabolism Physician
—
—
207RG0100X
Gastroenterology Physician
—
—
207RR0500X
Rheumatology Physician
—
—
208000000X
Pediatrics Physician
—
—
2085B0100X
Body Imaging Physician
—
—
208800000X
Urology Physician
—
—
208D00000X
General Practice Physician
—
—
208M00000X
Hospitalist Physician
Primary
—
—
363A00000X
Physician Assistant
—
—
363L00000X
Nurse Practitioner
—
CA
363L00000X
Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GR0068380
—
CA
05
—
GR0068381
—
CA
05
—
GR0068382
—
CA
05
—
GR0068383
—
CA
05
—
GR0068384
—
CA
05
—
GR0068385
—
CA
05
—
GR0068386
—
CA
05
—
GR0068387
—
CA
05
—
GR0068388
—
CA
05
—
GR006838A
—
CA
05
—
GR006838B
—
CA
Enumeration date
07/20/2006
Last updated
05/11/2009
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