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NPI Code Detail

MEDICARE: LAKESIDE SURGERY CENTER LP

MEDICARE: LAKESIDE SURGERY CENTER LP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QA1903XAmbulatory Surgical Clinic/Center

General Provider Information

NPI Number : 1760423297
Entity Type Code : Organization
Provider Name (Legal Business Name) : LAKESIDE SURGERY CENTER LP
Provider Business Mailing Address
First Line : 5700 SAN FERNANDO RD
Second Line :
City : GLENDALE
State : CA
Zip : 91202-2104
Country : US
Telephone Number : 818-637-7766
Fax Number : 818-956-1706
Provider Business Practice Location Address
First Line : 5700 SAN FERNANDO RD
Second Line :
City : GLENDALE
State : CA
Zip : 91202-2104
Country : US
Telephone Number : 818-637-7766
Fax Number : 818-956-1706
Authorized Official
Title or Position : ADMINISTRATOR
Name : LISA R DEBRUNO
Credential :
Telephone Number : 818-637-7766
Provider Enumeration Date : 06/08/2006
Last Update Date : 12/13/2007

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Directions to “LAKESIDE SURGERY CENTER LP ” Practice Location

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