| NPI | 1619975158 |
|---|---|
| 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 | 363L00000X Nurse Practitioner |
| 207R00000X Internal Medicine | |
| 208000000X Pediatrics | |
| Enumeration Date | 2005-07-08 |
| Last Update Date | 2009-05-06 |