| NPI | 1639487002 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEFFREY LAKE Physician/Owner 818-387-8725 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: CA A73315) |
| Enumeration Date | 2010-09-20 |
| Last Update Date | 2010-11-16 |