| Lakeside Medical Associates, A Medical Group, Inc. | |
|
12660 Riverside Dr Suite 225 N Hollywood CA 91607-3429 | |
| (818) 755-0265 | |
| (818) 753-9074 |
| Full Name | Lakeside Medical Associates, A Medical Group, Inc. |
|---|---|
| Speciality | Dermatology |
| Location | 12660 Riverside Dr, N Hollywood, California |
| Authorized Official Name and Position | Kerry E. Weiner (PRESIDENT) |
| Authorized Official Contact | 8186372000 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Lakeside Medical Associates, A Medical Group, Inc. 777 Flower St Ste A Glendale CA 91201-3000 Ph: (818) 637-2000 | Lakeside Medical Associates, A Medical Group, Inc. 12660 Riverside Dr Suite 225 N Hollywood CA 91607-3429 Ph: (818) 755-0265 |
| NPI Number | 1689869760 |
|---|---|
| Provider Enumeration Date | 09/11/2007 |
| Last Update Date | 05/06/2009 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1689869760 | NPI | - | NPPES |
| GR0068384 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Secondary |
| 207N00000X | Dermatology | (* (Not Available)) | Primary |
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