Provider Demographics
NPI:1336282052
Name:FRIEDMAN, GILLIAN STEPHANY (MD)
Entity Type:Individual
Prefix:DR
First Name:GILLIAN
Middle Name:STEPHANY
Last Name:FRIEDMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MS
Other - First Name:GILLIAN
Other - Middle Name:STEPHANY
Other - Last Name:HERALD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2701 HARBOR BLVD
Mailing Address - Street 2:STE E2-17
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626
Mailing Address - Country:US
Mailing Address - Phone:310-955-1805
Mailing Address - Fax:914-966-1494
Practice Address - Street 1:2080 S. E STREET
Practice Address - Street 2:
Practice Address - City:SAN BERNANDINO
Practice Address - State:CA
Practice Address - Zip Code:92408
Practice Address - Country:US
Practice Address - Phone:909-388-9191
Practice Address - Fax:909-388-9195
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-14
Last Update Date:2009-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA771582084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A771580Medicaid
CA00A771580Medicaid
CAH60192Medicare UPIN
H60192Medicare UPIN