Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Lake Side Medical Center Professional Inc

Organization Specialist · NPI 1740572395

Lake Side Medical Center Professional Inc is a Specialist in Los Angeles, California. Works from 2 locations. Licensed in California.

Licensed in
CA
In the registry since
2011
Specialties on file
2
What do these letters mean?
Inc — Incorporated
A form of business registration, not a clinical qualification.

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Practice location Address checks out

4300 Crenshaw Blvd
Los Angeles, CA 90008-4902
Phone: (323) 298-1668
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 9653 Alder Ave, Fontana, CA 92335-6129 — (909) 600-7002

Specialties & licences

Specialist (primary) Taxonomy 174400000X · Licence A76121 (CA)
Physiological Laboratory Taxonomy 293D00000X

Record details

NPI number1740572395
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Brian Gamble — President · (818) 985-1221
NPI enumeratedMay 13, 2011
Last updated in NPPESAugust 9, 2024
Certification dateAugust 9, 2024
Mailing address12115 Magnolia Blvd Ste 14, N Hollywood, CA 91607-2609

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