LAKE SIDE DIAGNOSTICS CENTER, INC. (NPI# 1558550129) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1558550129 |
| Entity Type | Organization |
| Organization Name | LAKE SIDE DIAGNOSTICS CENTER, INC. |
| Practice Address |
10701 Riverside Drive Suite 16 Toluca Lake CA 91602 |
| Practice Telephone | 8189851999 |
| Practice Fax Number | 8189851222 |
| Mailing Telephone | 8189851999 |
| Mailing Fax Number | 8189851222 |
| Enumeration Date | 2007-10-19 |
| Last Update Date | 2011-11-25 |
| Authorized Official Name | GARY T. JONES (PRESIDENT) |
| Authorized Official Telephone | 8189851999 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 293D00000X | Physiological Laboratory | Laboratories | ||
| N | 2471S1302X |
Radiologic Technologist Specialization: Sonography |
CA | Technologists, Technicians & Other Technical Service Providers | |
| N | 261QR0208X |
Clinic/Center Specialization: Radiology, Mobile |
CA | Ambulatory Health Care Facilities | |
| N | 261QR0208X |
Clinic/Center Specialization: Radiology, Mobile |
Ambulatory Health Care Facilities | ||
| N | 2471S1302X |
Radiologic Technologist Specialization: Sonography |
Technologists, Technicians & Other Technical Service Providers | ||
| Y | 293D00000X | Physiological Laboratory | CA | Laboratories |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CA | 3311838 | 05 |
| Street Address |
10701 RIVERSIDE DRIVE SUITE 16 |
| City | TOLUCA LAKE |
| State | CA |
| Zip Code | 91602 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679112882 | Da Oum Remnant Acupuncture Corporation | Acupuncturist | 10674 Riverside Drive, North Hollywood, CA 91602 | 2020-01-06 |
| 1043704927 | Brandi Carter | Nurse Practitioner | 10222 Camarillo St Apt 107, Toluca Lake, CA 91602 | 2018-06-14 |
| 1669904587 | Katelyn Story Kalstein | Naturopath | 11650 Riverside Dr., Ph-2a, Studio City, CA 91602 | 2017-03-30 |
| 1255781118 | Karla Morales | Dental Hygienist | 10707 Camarillo St, #305, West Toluca Lake, CA 91602 | 2016-06-21 |
| 1457738536 | Mallory Garrett | Marriage & Family Therapist | 10737 Riverside Dr, N Hollywood, CA 91602 | 2015-04-28 |
| 1831590322 | Victoria J. Chan | Nurse Practitioner | 4418 Vineland Avenue Suite 102, Toluca Lake, CA 91602 | 2014-09-16 |
| 1679916076 | Richard Villasenor | Ophthalmology | 10520 Camarillo St, Toluca Lake, CA 91602 | 2013-04-16 |
| 1275878233 | Julissa Trusty | Marriage & Family Therapist | 11334 Camarillo St, North Hollywood, CA 91602 | 2012-12-03 |
| 1265789531 | Marina Serobyan | Marriage & Family Therapist | 10999 Riverside Drive, Suite 306, Toluca Lake, CA 91602 | 2012-08-06 |
| 1407133457 | Hearing Aid Counselors, Inc | Durable Medical Equipment & Medical Supplies | 11008 Riverside Dr, Toluca Lake, CA 91602 | 2011-11-04 |
| Find all providers in zip 91602 | ||||
| Taxonomy Code | 293D00000X |
| Grouping | Laboratories |
| Classification | Physiological Laboratory |
| A laboratory that operates independently of a hospital and physician’s office to furnish physiological diagnostic services (e.g. EEG’s , EKG’s, scans, etc.). Facilities offering ONLY physiological services are not certified as independent laboratories. If an independent laboratory offers physiological services IN ADDITION to clinical laboratory services, they are surveyed only for compliance with the clinical laboratory regulations because there are no health and safety regulations for physiological services. |
| Notes: Source: Paraphrased from the Medicare Carrier Manual, Section 2070.5. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1740572395 | Lake Side Medical Center Professional. Inc. | Physiological Laboratory | 10701 Riverside Dr, Suite 16, Toluca Lake, CA 91602-2384 | 2011-05-13 |
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| 1306313648 | O.n. Diagnostics, LLC | Physiological Laboratory | 2150 Shattuck Ave Ste 610, Berkeley, CA 94704-1347 | 2018-10-24 |
| 1447731948 | Fountain Valley Regional Sleep Center LLC | Physiological Laboratory | 24953 Paseo De Valencia Ste 3a, Laguna Hills, CA 92653-4342 | 2018-08-23 |
| Find all providers with the same taxonomy | ||||
| City | TOLUCA LAKE |
| Zip Code | 91602 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.