MARK EDWARD GALLEGOS (NPI# 1649240722) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1649240722 |
| Entity Type | Individual |
| Full Name | MARK EDWARD GALLEGOS |
| Credential | PA |
| Practice Address |
15025 Innovation Dr San Diego CA 92128-3409 |
| Mailing Address |
File # 54433 Los Angeles CA 90074-0001 |
| Practice Telephone | 8584871800 |
| Practice Fax Number | 8587845644 |
| Mailing Telephone | 8587845767 |
| Mailing Fax Number | 8587845644 |
| Enumeration Date | 2006-01-23 |
| Last Update Date | 2014-06-19 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363A00000X | Physician Assistant | PA18490 | CA | Physician Assistants & Advanced Practice Nursing Providers |
| N | 363A00000X | Physician Assistant | PA756 | NV | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NV | 2402526 | 05 | |
| NV | 3102526 | 05 |
| Street Address |
15025 INNOVATION DR |
| City | SAN DIEGO |
| State | CA |
| Zip Code | 92128-3409 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1891896569 | Mark B. Kuhse | Emergency Medicine | 15025 Innovation Dr, San Diego, CA 92128-3409 | 2006-09-26 |
| 1962504431 | Ronald G. Salzetti | Obstetrics & Gynecology | 15025 Innovation Dr, San Diego, CA 92128-3409 | 2006-09-03 |
| 1407958978 | Danielle P. Twyman | Physician Assistant | 15025 Innovation Dr, San Diego, CA 92128-3409 | 2006-09-03 |
| 1225130792 | Marcelline K. Welsh | Pediatrics | 15025 Innovation Dr, San Diego, CA 92128-3409 | 2006-09-03 |
| 1033211685 | Julian J. Nicholas | Internal Medicine | 15025 Innovation Dr, San Diego, CA 92128-3409 | 2006-09-03 |
| 1275635831 | Michael J. Rundell | Emergency Medicine | 15025 Innovation Dr, San Diego, CA 92128-3409 | 2006-09-03 |
| 1477655082 | Margaret A. Drehobl | Family Medicine | 15025 Innovation Dr, San Diego, CA 92128-3409 | 2006-09-03 |
| 1346342995 | Clifford G. Feaver | Podiatrist | 15025 Innovation Dr, San Diego, CA 92128-3409 | 2006-09-03 |
| 1518069160 | Kimberly A. Longmire | Emergency Medicine | 15025 Innovation Dr, San Diego, CA 92128-3409 | 2006-09-03 |
| 1972605525 | Kevin W. Mcneely | Obstetrics & Gynecology | 15025 Innovation Dr, San Diego, CA 92128-3409 | 2006-09-03 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1518585371 | Alicia Ford | Behavior Technician | 1170 Bernardo Plaza Court, Suite 350, San Diego, CA 92128 | 2020-07-08 |
| 1164087573 | Madeleine White | Dietitian, Registered | 16685 W Bernardo Dr, Suite 121, San Diego, CA 92128 | 2019-05-01 |
| 1053807677 | Joele Ghosn | Speech-Language Pathologist | 11838 Bernardo Plaza Ct #110, San Diego, CA 92128 | 2018-07-06 |
| 1376034348 | Eddie Reginald Burston II | In Home Supportive Care | 12727 Camino Emparrado, San Diego, CA 92128 | 2018-05-24 |
| 1336659218 | Ryan Fong | Physician Assistant | 15004 Innovation Drive (s97), San Diego, CA 92128 | 2017-10-05 |
| 1508316191 | Araceli Flores | Behavioral Analyst | 15737 Innovation Dr, Suite 200, San Diego, CA 92128 | 2016-10-07 |
| 1003283961 | Katherine Dishner | Hearing Instrument Specialist | 16766 Bernardo Center Dr Ste 206, San Diego, CA 92128 | 2015-08-27 |
| 1205212586 | Mobilia Dmd Inc. | Point of Service | 12405 Rancho Bernardo Rd., San Diego, CA 92128 | 2015-08-10 |
| 1346623634 | Angela Christine Storck-petersen | Dietitian, Registered | 11768 Caminito Corriente, San Diego, CA 92128 | 2015-07-04 |
| 1134526874 | Breeana Rose Lancaster | Speech-Language Pathologist | 11838 Bernardo Plaza Ct. Suite 110, Kids Therapy Associates, San Diego, CA 92128 | 2014-11-24 |
| Find all providers in zip 92128 | ||||
| Taxonomy Code | 363A00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1083213706 | Courtney Kathryn Hopp | Physician Assistant | 4060 Fourth Ave Ste 209, San Diego, CA 92103-2120 | 2020-10-23 |
| 1639776503 | Nathan Tuan Dinh | Physician Assistant | 8296 Via Escalada, San Diego, CA 92129-2223 | 2020-10-05 |
| 1750988671 | Denise Aquino | Physician Assistant | 7322 Mesa College Dr Apt 7, San Diego, CA 92111-4943 | 2020-10-04 |
| 1962009183 | Courtney Krysl | Physician Assistant | 14434 Corte Lampara, San Diego, CA 92129-3818 | 2020-10-01 |
| 1497369284 | Brian Carroll | Physician Assistant | 7242 Melotte St, San Diego, CA 92119-1613 | 2020-08-31 |
| 1871104067 | Satoshi Ikeda | Physician Assistant | 16198 Paseo Del Sur, San Diego, CA 92127-6155 | 2020-08-12 |
| 1760009989 | Lili Tran | Physician Assistant | 8865 Calle Tragar, San Diego, CA 92129-2156 | 2020-07-03 |
| 1245857259 | Kendra Roberta Witt | Physician Assistant | 11396 Poblado Rd, San Diego, CA 92127-1351 | 2020-06-25 |
| 1336766344 | Brandon Scott Johnson | Physician Assistant | 1540 Oliver Ave Apt C, San Diego, CA 92109-5595 | 2020-06-25 |
| 1104441021 | Kira Ann Tellache | Physician Assistant | 4520 Executive Dr Ste 325, San Diego, CA 92121-3087 | 2020-06-16 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.