| NPI | 1275579252 |
|---|---|
| Doing Business As | LAKESIDE COMMUNITY HEALTHCARE MEDICAL GROUP |
| Entity Type | Organization |
| Authorized Contact | KERRY E. WEINER President 818-637-2000 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 207R00000X Internal Medicine |
| 363L00000X Nurse Practitioner | |
| Enumeration Date | 2006-06-20 |
| Last Update Date | 2009-05-06 |