Provider Demographics
NPI:1649880147
Name:PEDIATRIC OFFICE ANESTHESIA SPECIALISTS
Entity type:Organization
Organization Name:PEDIATRIC OFFICE ANESTHESIA SPECIALISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:GILLIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:858-254-0512
Mailing Address - Street 1:13990 MERCADO DR
Mailing Address - Street 2:
Mailing Address - City:DEL MAR
Mailing Address - State:CA
Mailing Address - Zip Code:92014-3124
Mailing Address - Country:US
Mailing Address - Phone:858-254-0512
Mailing Address - Fax:
Practice Address - Street 1:12625 HIGH BLUFF DR STE 301
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92130-2054
Practice Address - Country:US
Practice Address - Phone:858-254-0512
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-09
Last Update Date:2020-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP3000XAllopathic & Osteopathic PhysiciansAnesthesiologyPediatric AnesthesiologyGroup - Single Specialty