Provider Demographics
NPI:1871718528
Name:LAKE, GENE (GERALD) EUGENE (MD)
Entity type:Individual
Prefix:
First Name:GENE (GERALD)
Middle Name:EUGENE
Last Name:LAKE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:GENE
Other - Middle Name:
Other - Last Name:LAKE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:230 W LAUREL ST
Mailing Address - Street 2:UNTI 703
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92101-1461
Mailing Address - Country:US
Mailing Address - Phone:619-595-1564
Mailing Address - Fax:858-720-8285
Practice Address - Street 1:230 W LAUREL ST
Practice Address - Street 2:UNIT 703
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92101-1461
Practice Address - Country:US
Practice Address - Phone:619-595-1564
Practice Address - Fax:858-720-8285
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARG207482084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry