Gallegos, Mark Edward

Gallegos, Mark Edward is an individual health care provider with primary practice located at 15025 Innovation Dr , San Diego CA 92128-3409. He recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant, which is considered as his primary health care specialty. Gallegos, Mark Edward can be contacted via phone (858) 487-1800.

Contact Information

Primary practice address
15025 Innovation Dr San Diego CA 92128-3409
Phone: (858) 487-1800
Fax: (858) 784-5644
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X PA756 Nevada
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X PA18490 California

Profile Details

NPI number 1649240722
LBN Legal business name Gallegos, Mark Edward
Credentials Physician Assistant (PA)
Entity Individual
Sole proprietor 1 No
Enumeration date Jan 23rd, 2006
Last updated Jun 19th, 2014 - about 11 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1649240722 NPPES
Nevada MEDICAID 2402526
Nevada MEDICAID 3102526

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