Healthcare Provider Details

I. General information

NPI: 1770468548
Provider Name (Legal Business Name): SCOTT GILLIN MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2025
Last Update Date: 12/23/2025
Certification Date: 12/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1953 SAN ELIJO AVE STE 200
CARDIFF CA
92007-2348
US

IV. Provider business mailing address

13990 MERCADO DR
DEL MAR CA
92014-3124
US

V. Phone/Fax

Practice location:
  • Phone: 858-215-2618
  • Fax:
Mailing address:
  • Phone: 858-254-0512
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code207LP3000X
TaxonomyPediatric Anesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. SCOTT GILLIN
Title or Position: OWNER
Credential: MD
Phone: 858-254-0512