| NPI | 1770516304 |
|---|---|
| Other Name | LAKESIDE HEALTH CENTER |
| Entity Type | Organization |
| Authorized Contact | TIM DOLAN CFO 707-467-2260 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Additional Taxonomies | 261Q00000X Clinic/Center (Licence: CA 110000350) |
| Enumeration Date | 2006-07-08 |
| Last Update Date | 2019-05-03 |