Provider Demographics
NPI:1871864827
Name:SCOLNICK, JILL LAUREN (DO)
Entity type:Individual
Prefix:DR
First Name:JILL
Middle Name:LAUREN
Last Name:SCOLNICK
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:28076 VIA RUEDA
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN CAPISTRANO
Mailing Address - State:CA
Mailing Address - Zip Code:92675-3365
Mailing Address - Country:US
Mailing Address - Phone:626-253-0910
Mailing Address - Fax:626-361-4279
Practice Address - Street 1:28076 VIA RUEDA
Practice Address - Street 2:
Practice Address - City:SAN JUAN CAPISTRANO
Practice Address - State:CA
Practice Address - Zip Code:92675-3365
Practice Address - Country:US
Practice Address - Phone:626-253-0910
Practice Address - Fax:626-361-4279
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-23
Last Update Date:2021-01-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA20A14284208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation