Provider Demographics
NPI:1730703877
Name:PAYTON, MCKENZIE LEE (PA-C)
Entity type:Individual
Prefix:
First Name:MCKENZIE
Middle Name:LEE
Last Name:PAYTON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26162 CANARY CT
Mailing Address - Street 2:
Mailing Address - City:LAKE FOREST
Mailing Address - State:CA
Mailing Address - Zip Code:92630-7271
Mailing Address - Country:US
Mailing Address - Phone:949-485-9641
Mailing Address - Fax:
Practice Address - Street 1:29100 PORTOLA PKWY STE B
Practice Address - Street 2:
Practice Address - City:LAKE FOREST
Practice Address - State:CA
Practice Address - Zip Code:92630-8713
Practice Address - Country:US
Practice Address - Phone:949-768-8478
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-04
Last Update Date:2024-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA58362363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical