Provider Demographics
NPI:1750569240
Name:PAYNE-FRIEDICK, JILLIAN VIRGINIA (PA-C)
Entity type:Individual
Prefix:MS
First Name:JILLIAN
Middle Name:VIRGINIA
Last Name:PAYNE-FRIEDICK
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:JILLIAN
Other - Middle Name:VIRGINIA
Other - Last Name:PAYNE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:460 HIGHVIEW ST
Mailing Address - Street 2:
Mailing Address - City:NEWBURY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91320-5028
Mailing Address - Country:US
Mailing Address - Phone:562-244-9127
Mailing Address - Fax:
Practice Address - Street 1:701 N WENDY DR
Practice Address - Street 2:
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91320-3066
Practice Address - Country:US
Practice Address - Phone:805-375-4400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-06
Last Update Date:2023-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA 19424363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant