Graduated: 2007
NPI: 1386823607
Practice Locations (2)
LAKESIDE MEDICAL ORGANIZATION A MEDICAL GROUP INC
1500 S CENTRAL AVE, SUITE 200
GLENDALE, CA 912043853
8182914010
LAKESIDE MEDICAL ORGANIZATION A MEDICAL GROUP INC
1500 W W COVINA PKWY
WEST COVINA, CA 917902708
6264309991
Source: CMS National Downloadable File, September 2026.