Healthcare Provider Details

I. General information

NPI: 1013988435
Provider Name (Legal Business Name): SHAKHA V GILLIN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/01/2006
Last Update Date: 06/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12845 POINTE DEL MAR SUITE 200
DEL MAR CA
92014
US

IV. Provider business mailing address

12845 POINTE DEL MAR SUITE 200
DEL MAR CA
92014
US

V. Phone/Fax

Practice location:
  • Phone: 858-794-7337
  • Fax: 858-794-7338
Mailing address:
  • Phone: 858-794-7337
  • Fax: 858-794-7338

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA070287
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: