Healthcare Provider Details

I. General information

NPI: 1407512791
Provider Name (Legal Business Name): LAKESIDE MEDICAL GROUP HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/11/2021
Last Update Date: 07/29/2025
Certification Date: 07/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

LAKESIDE MEDICAL GROUP HOSPITAL HIDALGO 148A
CHAPALA JALISCO
45920
MX

IV. Provider business mailing address

LAKESIDE MEDICAL GROUP HOSPITAL 302 WASHINGTON ST #150-3509
SAN DIEGO CA
92103
US

V. Phone/Fax

Practice location:
  • Phone: 888-449-7799
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number
License Number State

VIII. Authorized Official

Name: IAN FISCHMAN
Title or Position: MANAGER
Credential: MD
Phone: 650-417-1127