Provider Demographics
NPI:1194832634
Name:GILLAN, JAMES K (PA C)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:K
Last Name:GILLAN
Suffix:
Gender:M
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 1:332 SANTA FE DR
Mailing Address - Street 2:SUITE 110
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-5143
Mailing Address - Country:US
Mailing Address - Phone:760-943-6700
Mailing Address - Fax:760-632-4292
Practice Address - Street 1:332 SANTA FE DR
Practice Address - Street 2:SUITE 110
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-5143
Practice Address - Country:US
Practice Address - Phone:760-943-6700
Practice Address - Fax:760-632-4292
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2013-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA 18037363A00000X
CAPA18037363AM0700X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q54861Medicare UPIN
CAWPA18037BMedicare ID - Type Unspecified
CAWPA18037AMedicare ID - Type Unspecified