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:
Health care specialties
| Specialty | Code | License # | 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1649240722 | NPPES |
| Nevada | MEDICAID | 2402526 | |
| Nevada | MEDICAID | 3102526 |
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