| Lake Medical Center, Inc. | |
|
1146 San Marino Dr, San Marcos, CA 92078-4649 | |
| (760) 471-2033 | |
| (760) 471-2083 |
| Full Name | Lake Medical Center, Inc. |
|---|---|
| Type | Facility |
| Speciality | Psychiatry & Neurology - Neurology |
| Location | 1146 San Marino Dr, San Marcos, California |
| Accepts Medicare Assignments | Medicare enrolled and accepts medicare insurance. Providers at this facility may prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1689863714 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 111N00000X | Chiropractor | DC17617 (California) | Secondary |
| 2084N0400X | Psychiatry & Neurology - Neurology | G26382 (California) | Primary |
| Provider Name | Ronald Shimmin |
|---|---|
| Provider Type | Practitioner - Preventive Medicine |
| Provider Identifiers | NPI Number: 1225153315 PECOS PAC ID: 8628124047 Enrollment ID: I20090925000267 |
| Provider Name | Aziz N Ander |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1316131832 PECOS PAC ID: 9032385323 Enrollment ID: I20120109000667 |
| Provider Name | Jill-ellen A Mauser |
|---|---|
| Provider Type | Practitioner - Chiropractic |
| Provider Identifiers | NPI Number: 1033274311 PECOS PAC ID: 0345409132 Enrollment ID: I20120314000678 |
| Provider Name | Lance F Jeppesen |
|---|---|
| Provider Type | Practitioner - Chiropractic |
| Provider Identifiers | NPI Number: 1750439451 PECOS PAC ID: 0345409140 Enrollment ID: I20120314000787 |
| Provider Name | Dale M Mauser |
|---|---|
| Provider Type | Practitioner - Chiropractic |
| Provider Identifiers | NPI Number: 1366505497 PECOS PAC ID: 0042479776 Enrollment ID: I20120315000325 |
| Mailing Address | Practice Location Address |
|---|---|
| Lake Medical Center, Inc. 1146 San Marino Dr, San Marcos, CA 92078-4649 Ph: (760) 471-2033 | Lake Medical Center, Inc. 1146 San Marino Dr, San Marcos, CA 92078-4649 Ph: (760) 471-2033 |