Provider Demographics
NPI:1801260773
Name:GERALD GOLLIN MD, INC.
Entity type:Organization
Organization Name:GERALD GOLLIN MD, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLLIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:909-633-5238
Mailing Address - Street 1:317 N EL CAMINO REAL
Mailing Address - Street 2:STE 502
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-2811
Mailing Address - Country:US
Mailing Address - Phone:760-634-4090
Mailing Address - Fax:760-634-4094
Practice Address - Street 1:317 N EL CAMINO REAL
Practice Address - Street 2:STE 502
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-2811
Practice Address - Country:US
Practice Address - Phone:760-634-4090
Practice Address - Fax:760-634-4094
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-16
Last Update Date:2015-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG0849532086S0120X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0120XAllopathic & Osteopathic PhysiciansSurgeryPediatric SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1477598662Medicaid