Type | Company | [sources] | |||
---|---|---|---|---|---|
Name | Lake, Gerald E MD Inc. | [sources] | |||
Incorporation date | not available | [sources] | |||
Jurisdiction | not available | [sources] | |||
Country | United States | [sources] | |||
Registration number | 00G207480 · ZZZ79426 | [sources] | |||
Sector | Corporation Owner | [sources] | |||
Address | 230 West Laurel St., Ste. #704, San Diego, CA · 4671 Fair Oaks Blvd., Sacramento, CA · 7737 Fair Oaks Blvd., Unit #469, Carmichael, CA | [sources] | |||
Last change | Last processed | First seen |
Medical providers suspended from or otherwise deemed ineligible to participate in California's Medicaid program.
United States · DHCS
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