Provider Demographics
NPI:1013988435
Name:GILLIN, SHAKHA V (MD)
Entity Type:Individual
Prefix:
First Name:SHAKHA
Middle Name:V
Last Name:GILLIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12845 POINTE DEL MAR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:DEL MAR
Mailing Address - State:CA
Mailing Address - Zip Code:92014
Mailing Address - Country:US
Mailing Address - Phone:858-794-7337
Mailing Address - Fax:858-794-7338
Practice Address - Street 1:12845 POINTE DEL MAR
Practice Address - Street 2:SUITE 200
Practice Address - City:DEL MAR
Practice Address - State:CA
Practice Address - Zip Code:92014
Practice Address - Country:US
Practice Address - Phone:858-794-7337
Practice Address - Fax:858-794-7338
Is Sole Proprietor?:No
Enumeration Date:2006-02-01
Last Update Date:2012-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA070287208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics